The Cushing's syndrome It is a rare medical condition caused by an excess of the hormone cortisol in the body. Cortisol is a hormone produced by the adrenal glands that is released in stressful situations such as fear, illness, etc..
When the body is subjected to high levels of cortisol for a long period of time, many of the characteristic symptoms of Cushing's syndrome or hypercortisolism may appear: increased blood pressure, weight gain, loss of bone mass, skin changes, among others,
Cushing's syndrome is a rare disease that can be caused by a wide variety of factors such as tumors in the adrenal glands, excess production of adrenocorticotropic hormone (ACTH), exposure to glucocorticoid drugs, etc..
Generally, different tests and laboratory analyzes are used to confirm the presence of Cushing's syndrome, since the varied symptoms do not allow a precise clinical diagnosis.
Regarding treatment, the most effective interventions refer to those aimed at controlling or eliminating the etiological causes: removal of tumors, removal of adrenal glands, suspension of medication, etc..
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Cushing's syndrome or Hypercortislism is an endocrine or metabolic type pathology (CSRF, 2016) and can be defined as a set of symptoms and signs resulting from the persistent and abnormal elevation of cortisol levels in the blood.
Therefore, Cushing's syndrome develops when cortisol levels are abnormally high. Although it may be due to different factors, one of the most frequent is the excessive consumption of glucocorticoid drugs.
Among the most notable characteristics of Cushing's syndrome is an increase in weight in the upper part of the body, a rounded face and a propensity to suffer from skin bruises..
What is cortisol?
Cortisol is a type of hormone that belongs to the group of glucorticoids, since it has a prominent role in the metabolism of proteins and carbohydrates.
Glucoroticoids contribute to the production of fats as a source of energy, increase blood flow and also stimulate body reactivity, among other functions,
Specifically, cortisol is produced by the adrenal cortex and is known as the "stress hormone”(Carlson, 2010), since it frees itself in situations of tension.
Specifically, cortisol contributes to maintaining blood pressure levels, reduces the inflammatory response of the immune system, regulates the metabolism of proteins, carbohydrates or fats..
In addition, cortisol allows the body to respond to stressful environmental demands, generating enough energy to maintain the vital functions of the body..
However, when various conditions result in prolonged exposure of the body tissues to high levels of cortisol, various medical conditions may appear, including Cushing's syndrome..
Cushing's syndrome is a rare medical condition (Healthline, 2016).
Although there are few statistical data about the occurrence of this syndrome, it is estimated that it has a prevalence of one case per 50,000 people (NHS, 2015).
Cushing's syndrome can affect anyone, but is most common in adults between the ages of 20 and 50 (Healthline, 2016). In addition, women are three times more likely to suffer from it than men (NHS, 2015).
The signs and symptoms caused by Cushing's syndrome can vary between those affected..
Some people will develop only some of the symptoms or several in a mild way, such as weight gain. However, in other more severe cases of Cushing syndrome, those affected may have almost all the characteristic symptoms of the disease (Nieman & Swearingen, 2016).
The most characteristic and common signs and symptoms of Cushing syndrome are (Nieman & Swearingen, 2016):
Apart from these, other signs and symptoms that occur frequently in this pathology have also been observed:
On the other hand, Cushing's syndrome can also generate various symptoms at the skin and bone level:
Also, Cushing's syndrome in women produces some specific signs and symptoms:
In the case of men it can also produce:
In addition to these varied symptoms, it is also possible that another series of less frequent medical events occur as a result of suffering from this pathology:
Cushing's syndrome, as we have noted above, occurs when our body is exposed to excessive or abnormally high levels of cortisol for a long period of time.
In many cases of Cushing syndrome, people who suffer from it usually present symptoms as a result of taking drugs that contain glucocorticoid hormones such as some of the treatments for asthma, arthritis, lupus, etc. (Massachusetts General Hospital, 2016).
In other cases, the characteristic symptoms of Cushing syndrome develop as a consequence of an imbalance in cortisol production. In addition, some people who suffer from alcoholism, depression, panic disorders, or malnutrition, may also have elevated levels of cortisol (Massachusetts General Hospital, 2016).
Prolonged intake of high-dose corticosteroid drugs can increase corticol levels and unbalance its production..
Oral corticosteroids are used in the treatment of some inflammatory diseases such as rheumatoid arthritis, lupus and aspa, or with an immunosuppressive function (Mayo Clinic, 2013).
One of these drugs is prednisone, which has the same effect on the body as cortisol produced by the body. Because it is necessary to use it in high doses, side effects may appear, such as Cushing's syndrome due to excess cortisol (Mayo Clinic, 2013).
In addition to oral corticosteroids, Cushing's syndrome can also occur associated with the use of injectable corticosteroids such as those aimed at reducing joint pain, back pain, etc. (Mayo Clinic, 2013).
Inlate steroid drugs (asthma treatment) and steroid lotions (eczema treatment) are less likely to cause Cushing's syndrome (Mayo Clinic, 2013).
Cushing's syndrome can also develop as a result of high cortisol production by the body.
In this case, Cushing's syndrome may be caused by an increase in the production of cortisol by the adrenal glands or an overproduction of the adrenocorticotropic hormone, responsible for controlling the production of cotisol.
Some of the conditions that are related to an overproduction of cortisol are (Massachusetts General Hospital, 2016):
Not all those affected by Cushing's syndrome present the same symptoms and course, in addition to high blood pressure and weight gain, are common conditions in the general population, so the precise and clinical diagnosis of Cushing's syndrome can be complicated (Nieman & Swearingen, 2016).
Medical specialists often use different diagnostic and laboratory tests to determine both the presence of the syndrome and the etiological cause (Nieman & Swearingen, 2016).
The most widely used diagnostic tests are those that measure free cortisol levels in 24-hour urine, blood and saliva (Spanish Society of Pediatric Endocrinology, 2016).
In addition, it is also possible to determine the excessive production of cortisol by the body through the dexamethasone suppression test. An oral drug is used to determine the concentration of cortisol through its regulation (Nieman & Swearingen, 2016).
Although these tests are the most common, they do not always reliably diagnose Cushing syndrome, mainly because it can be caused by various medical pathologies (Nieman & Swearingen, 2016).
Therefore, it is usual to use other diagnostic procedures such as (Spanish Society of Pediatric Endocrinology, 2016):
Treatment for Cushing's syndrome essentially depends on the cause of the excess cortisol.
If the cause is related to the persistent intake of corticosteroid medications used to treat other pathologies, medical specialists may reduce the doses until the symptoms of Cushing's syndrome are controlled..
In the case of the presence of tumors as an etiological factor of Cushing's syndrome, interventions such as surgery, radiotherapy, chemotherapy, immunotherapy, etc. may be used..
Therefore, the treatment of Cushing's syndrome may include:
a) Reduction of corticosteroid medication.
b) Surgical treatment: pituitary surgery, adrenalectomy, removal of ACTH-producing tumor.
c) Radiation therapy, chemotherapy, immunotherapy.
d) Pharmacological treatment to reduce the level of cortisol.
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