Cushing Syndrome – causes, symptoms, treatment
- glomerular area – at this level mineralocorticoid hormones are secreted (aldosterone, dezoxicorticosteron);
- fasciculated zone – the area which produces glucocorticoid hormones (corticosterone, cortisol, cortisone);
- reticulated area – produces androgens (testosterone, androstenlion, dehydroepiandrosterone) and a small amount of estrogen (estrone, estradiol).
Adrenal activity is under hypothalamic control (through secretion of corticoliberin) and pituitary control (through the secretion of adrenocorticotropic hormone).
Cushing syndrome is a condition that has as clinical expression the hyperfunction of adrenal gland. This syndrome occurs with predilection for women, with onset predominantly in the second decade of life (20 years).
Cushing’s Syndrome Causes
In terms of etiology, the syndrome may be caused by a benign tumor (adenoma of fasciculated area) that secrete glucocorticoids, or a malignanttumor (carcinoma). This malignancy (cancer) may present anarchic secretion of steroid hormones (mineralocorticoids, glucocorticoids), resulting a complex clinical picture.
Itenko-Cushing’s syndrome is made by hypothalamic dysfunction with excess secretion of corticoliberine (CRH) which stimulates the pituitary causing excessive secretion of adrenocorticotropic hormone which in turn will stimulate the adrenal gland, resulting in an hormonal excess of this gland.
If adrenocortical hypersecretion is due to an adenoma (benign tumor) located at the pituitary gland, which secretes adrenocorticotropic hormone and which in turn stimulates the adrenal gland secretion, then the condition is called Cushing’s disease.
There can be seen a paraneoplastic Cushing (a series of bronchial malignancies, of thymus, of pancreas can secrete adrenocorticotropic substances acting hormone-like).
If the tumor, localized at adrenal level, predominantly secretes cortisol then appears the clinical picture of hypercortizolism. It is characterized by an insidious onset, with weight gain, appearance of hyperpilosity (overgrowth of hair), blood pressure fluctuations, menstrual disorders in women, sexual dynamic disturbances both in men and women.
The state period of the disease is characterized by the following signs and symptoms:
– Obesity – affects the face and trunk, but respects the members;
– Skin – are harsh, dry, purple stretch marks (located on the abdomen, thighs and armpit), ecchymosis (bruising), acne, virilism in women;
– Facies – is red, vultuos;
– Muscle – at this level may occur severe muscle atrophy with physical fatigue;
– Bones – bone demineralization occurs with predominant involvement of the vertebrae, ribs, pelvic bones. This demineralization process can lead to severe pain or fractures;
– Cardio-vascular system – hypertension appears;
– Nervous system, mental disorders such as emotional lability, anxiety, depression, impaired memory and concentration;
– Uro-genital apparatus – in women can occur virilizing syndrome (hair extends typically like male distribution areas – face, anterior chest, the lower abdomen, the front of the thighs; voice thickens) if the tumor secrete an excess of androgens, also in this context, can install the defeminization phenomena (menstrual disorders, sterility, frigidity);
– In men – hair growth intensifies, testicles atrophy, impotence occurs, gynecomastia (growth of mammary glands in men);
– Associated endocrine disorders – endocrine secondary hypothyroidism and diabetes.
For diagnosis of Cushing’s sydrome laboratory determinations are necessary: metabolic, hormonal and imaging exams.
The blood picture is characterized by: neutrophilia (increased neutrophils), lymphopenia, eozinopeniaand increased platelet count.
Metabolic analysises highlights:
– Glucose – increased;
– Lipids – high;
– Cholesterol – increased;
– Plasma Na – increased;
– K from plasma – decreased;
Hormonal determinations consists of dosing plasma cortisol (which is increased) and disappears the normal rhythm of secretion.
Imaging consist in CT (may reveal an adrenal tumor), turkish saddle ray (may reveal a pituitary tumor), and skeletal X-rays (for diagnosis of osteoporosis).
Cushing syndrome is a chronic condition in which evolution can occur a number of complications. The most important complications that may occur are hypertension, heart failure, steroid diabetes, low resistance to infections, severe mental disorders with depressive phenomena with a tendency to suicide.
Cushing syndrome treatment
Treatment of Cushing’s syndrome depends on the etiology of this disorder. If the substrate of this disease is a adrenocortical tumor (benign or malignant) then will be practiced the unilateral removal of the adrenal gland. Surgery is followed by hormone replacement therapy with glucocorticoids.
If the substrate of the condition is represented by an inoperable carcinoma (cancer) then is used chemotherapy.
In Cushing’s disease the treatment addresses both to adrenal gland and pituitary gland (pituitary radiotherapy – to prevent tumor growth at this level).
In Cushing’s paraneoplastic syndrome the treatment is addressed primarily to tumor.