General Illness Information
Common Name:
Cushing’s Disease, Cushing’s syndrome.
Medical Term: Cushing’s Disease, Cushing’s syndrome
Description: Clinical abnormalities associated with chronic exposure to excessive amounts of cortisol.
Causes: The most frequent cause is prolonged use of steroid medications (Cortisone, or ACTH).
Other causes:
- ACTH-secreting pituitary tumor;
- Ectopic ACTH production (e.g., small-cell carcinoma of lung, bronchial carcinoid);
- Endogenous ACTH-independent hypercortisolism: Adrenal adenoma, Adrenal carcinoma, Macro/micro nodular hyperplasia of the adrenal gland.
Prevention:
Avoid excessive corticosteroid treatment when possible.
Signs & Symptoms
- Moon face, Increased fat tissue in neck and trunk;
- Central weight gain;
- Emotional ups and downs;
- Hypertension;
- Osteoporosis;
- Purple striae on the skin;
- Diabetes;
- Muscle weakness due to loss of muscle mass from increased catabolism;
- Skeletal growth retardation in children;
- Easy bruising;
- Hirsutism
Risk Factors
- Any medical problem requiring prolonged use of corticosteroids;
- Pituitary tumor;
- Adrenal mass
Diagnosis & Treatment
Blood tests will reveal abnormalities in: 24 hour urinary cortisol, Plasma cortisol (am and pm), Plasma ACTH concentration, Blood sugar levels, electrolytes, lipids. Imaging: Chest films X-rays of the lumbar spine – osteoporosis is common. If pituitary tumor suspected – pituitary MRI scan. If adrenal disease suspected – abdominal CT scan. If ectopic ACTH-secretion suspected – chest CT scan.
General Measures:
Treatment depends on cause. Surgery is the treatment of choice; persistent disease may require – radiation, drug therapy, or surgery
Medications:
Anti-adrenal drugs have not been successful, but are used by skilled physicians when all other treatments have failed.
Activity:
As tolerated, in accordance with symptoms and treatment.
Diet:
- Potassium supplements;
- High protein diet
Possible Complications :
- Osteoporosis;
- Increased susceptibility to infections;
- Hirsutism;
- Metastases of malignant tumors
Prognosis
Guardedly favorable prognosis with surgery
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