Cushing’s syndrome

Why in News?

Recent studies have reported expanding treatment options for Cushing’s syndrome, particularly for patients who are not candidates for surgery or whose disease persists after surgery.

• Cushing’s syndrome – It happens when there is too much cortisol in the body over a long period.
• Cortisol is produced by the adrenal glands and helps control blood pressure, metabolism, immunity, and the body’s response to stress. When cortisol remains high, it affects many organs.
• Types – Exogenous Cushing syndrome - The most common cause is long-term use of steroid medicines prescribed for asthma, autoimmune diseases, arthritis, or after organ transplants.
• Endogenous Cushing’s syndrome - In endogenous Cushing’s syndrome on the other hand, the body produces excess cortisol on its own.
• This is usually due to a non-cancerous tumour in the pituitary gland (called Cushing’s disease).

The pituitary gland is a small gland located at the base of the brain.

• Less commonly, it may be caused by tumours in the adrenal glands or by tumours elsewhere in the body that produce ACTH (adrenocorticotropic hormone).

Adrenocorticotropic hormone, a hormone normally released by the pituitary gland.

• Signs & Symptoms - Rare condition affecting 1–3 people per million annually; often misdiagnosed due to similarity with Obesity or Type 2 Diabetes.
• Early signs - Weight gain around abdomen and face; rounded “moon face” and fat buildup between shoulders.
• Skin changes - Thin skin, easy bruising, slow wound healing, purple stretch marks; acne and excess facial/body hair (in women).
• Hormonal effects- Irregular/absent periods in women; reduced libido or fertility in men.
• Muscle & energy - Muscle weakness (arms and thighs) and persistent fatigue.
• Metabolic effects - High blood pressure, high blood sugar/diabetes, increased cholesterol.
• Bone & mental health - Osteoporosis risk, mood swings, anxiety, depression, sleep problems, memory and concentration issues.
• Immune impact- Increased susceptibility to infections.
• Children -Weight gain with slowed height growth.
• Complications if untreated- Higher risk of heart disease, blood clots, infections.
• Vulnerable age groups - People who take steroid medicines for a long time are at highest risk. Even moderate doses over time can increase cortisol levels.
• Women are more commonly affected than men in naturally occurring (endogenous) cases, especially between ages 30 and 50.
• Although rare, Cushing’s syndrome can be life-threatening if left untreated.
• Treatment - Medication-Induced - If caused by steroid use, doses are tapered gradually under medical supervision.
• Surgical Intervention - Usually the first-line treatment for tumors.
• Pituitary Tumors - Removed via specialized neurosurgery.
• Adrenal Tumors- May require removal of the affected gland (adrenalectomy).
• Alternative Therapies- If surgery is not an option or is incomplete, radiation therapy or cortisol-blocking medications are used.
• Recovery & Monitoring - Temporary Replacement: Patients may need cortisol supplements until natural production stabilizes.
• Long-term Care: Regular follow-ups are essential as the condition can recur.

Reference

The Hindu | Cushing’s syndrome