Cushing's syndrome is a collection of symptoms that arise due to too high levels of the hormone cortisol in the body. These symptoms can appear suddenly or gradually, and can get worse if left untreated.
Cortisol is a hormone produced by the adrenal glands. This hormone has many important functions for the body, including maintaining the function of the heart and blood vessels, reducing inflammation, and controlling blood pressure and blood sugar levels.
However, too high levels of the hormone cortisol (hypercortisolism) in Cushing's syndrome can cause various disorders in the body. In addition, this condition can also increase the risk of chronic diseases, including type 2 diabetes.
Causes of Cushing's Syndrome
High levels of the hormone cortisol in Cushing's syndrome can be caused by factors from outside the body (external) or from within the body (internal). Here is the explanation:
External causes of Cushing's syndrome
The most common cause of Cushing's syndrome is the use of corticosteroid drugs in high doses or for a long time. This can happen because corticosteroid drugs have the same effect as the hormone cortisol.
Corticosteroid drugs that often cause Cushing's syndrome are drugs that are taken orally and injected. However, in rare cases, inhaled and topical corticosteroids can also cause Cushing's syndrome, especially when used in high doses.
Internal causes of Cushing's syndrome
Cushing's syndrome can also occur due to high levels of adrenocorticotropic hormone (ACTH), a hormone that regulates the formation of the hormone cortisol. Excessive ACTH levels can be caused by:
- Tumors in the pituitary gland or pituitary
- Tumors in the pancreas, lungs, thyroid gland, or thymus gland
- Tumors in the endocrine glands associated with heredity
- Diseases of the adrenal glands, such as a tumor in the adrenal cortex (adrenal adenoma)
Cushing's syndrome risk factors
Cushing's syndrome is more at risk for adults aged 30-50 years. However, it is possible for this condition to occur in children. In addition, Cushing's syndrome is also three times more likely to affect women than men.
Cushing's syndrome is more likely to occur in people who need to receive corticosteroid medications long-term. The example is:
- Chronic asthma sufferers
- Rheumatoid arthritis sufferers
- Lupus sufferers
- Organ transplant recipient
SymptomCushing's syndrome
Symptoms experienced by sufferers of Cushing's Syndrome depend on the high levels of cortisol in the body. Symptoms include:
- Weight gain
- Accumulation of fat, especially in the shoulders (buffalo hump) and face (moon face)
- Reddish purple streaks (striae) on the skin of the abdomen, thighs, breasts, or arms
- Thinning of the skin, so the skin becomes easy to bruise
- Wounds or insect bites on the skin are difficult to heal
- Pimple
- muscle weakness
- Weak
- Depression, anxiety, or irritability
- Impaired memory
- High blood pressure
- Headache
- Bone loss
- Growth disorders in children
In women, Cushing's syndrome can make menstruation irregular or late and cause symptoms of hirsutism, which is hair that grows thick on the face or other parts that usually only grows in men.
Meanwhile, in men, other complaints that may arise due to Cushing's syndrome are decreased sexual desire, impaired fertility, and impotence.
When to go to the doctor
Check with your doctor if you experience the above symptoms, especially if you are on treatment with high-dose corticosteroid drugs. It's important to remember that the sooner Cushing's syndrome is treated, the better the chances of a cure.
Cushing's Syndrome Diagnosis
The doctor will ask the patient about the symptoms they are experiencing and the history of the drugs they take regularly. After that, the doctor will perform a thorough physical examination to look for signs of Cushing's syndrome in the patient.
To confirm the diagnosis and rule out other possible diseases, the doctor will run additional tests, such as:
- Examination of 24-hour urine samples and saliva at night, to measure cortisol hormone levels
- Examination of the level of the hormone cortisol in the blood, can be done with the introduction of a low dose of dexamethasone at night, to see if the patient's cortisol level will drop in the morning.
- Scan with a CT scan or MRI, to see if there is a tumor on the adrenal gland or pituitary gland
- Test a blood sample taken from the petrosal sinus, which is the blood vessel around the pituitary gland, to determine whether Cushing's syndrome is caused by a disorder of the pituitary gland or not
Cushing's Syndrome Treatment
Cushing's syndrome treatment aims to reduce cortisol levels in the body. The treatment method chosen will be tailored to the underlying cause.
The following are some of the treatment methods that doctors can use to treat Cushing's syndrome:
- Gradually reduce the dose of corticosteroids or replace corticosteroids with other drugs, if Cushing's syndrome is caused by high or long-term use of corticosteroids
- Undergo a surgical procedure to remove the tumor, if Cushing's syndrome is caused by a tumor
- Perform radiation therapy procedures (radiotherapy), if there is still a tumor remaining after surgery or if surgery cannot be performed
- Administer medications to control cortisol levels, such as ketoconazole, metyrapone, mitotane, and mifepristone, if surgery and radiotherapy are not effective in treating the patient
Cushing's syndrome treatment can affect other hormones produced by the adrenal glands. Therefore, in some cases, patients need to receive hormone replacement therapy.
Complications of Cushing's Syndrome
If left untreated, Cushing's syndrome can lead to serious complications, such as:
- Severe depression
- Diabetes
- High cholesterol
- Easy to get infected
- Bone loss (osteoporosis) and fractures
- Loss of muscle mass
- Blood clots in the legs or lungs
- Heart attack
- stroke
- Death
Cushing's Syndrome Prevention
Cushing's syndrome associated with tumors is difficult to predict and prevent. However, Cushing's syndrome caused by high doses or long-term use of corticosteroids can be reduced by having regular check-ups with your doctor to check your health and hormone levels.