General Illness Information
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.
Avoid excessive corticosteroid treatment when possible.
Signs & Symptoms
Moon faceÂ 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
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
Treatment depends on cause. Surgery is the treatment of choice; persistent disease may require – radiation, drug therapy, or surgery
Anti-adrenal drugs have not been successful, but are used by skilled physicians when all other treatments have failed.
As tolerated, in accordance with symptoms and treatment.
Potassium supplements High protein diet
Possible Complications :
Osteoporosis Increased susceptibility to infections Hirsutism Metastases of malignant tumors
Guardedly favorable prognosis with surgery