Cushing's syndrome

Cushing's syndrome is a disease caused by a long-term increase in the level of the hormone cortisol in the body. It can result from overproduction of cortisol directly in the adrenal glands or arise secondarily — for example, due to the production of adrenocorticotropic hormone (ACTH) in the pituitary gland or other tumors.

Typical symptoms

  • Obesity with typical fat deposits in the area of the torso, face (“marigold face”) and neck
  • Thin skin that hurts easily, purple stretch marks (especially in the armpits)
  • Muscle weakness, especially in the limbs
  • High blood pressure and glucose tolerance disorders or diabetes
  • Menstrual disorders in women, decreased libido, osteoporosis
  • Psychological changes: irritability, depression, sleep disorders

Diagnostics

Diagnosis of Cushing's syndrome is challenging and takes place in multiple steps. First of all, it is verified that there is indeed an increased level of cortisol in the body:

  • 1 mg dexamethasone suppression test — verification of whether the body suppresses the production of cortisol after administration of the drug, the use of additional special tests is possible
  • Measurement of free cortisol in urine (24-hour collection)
  • Nocturnal salivation for cortisol
  • Measurement of ACTH in the blood

After confirmation of elevated cortisol levels, the source is searched for — using imaging methods (CT/MRI of the adrenal glands, pituitary gland) and possibly other tests.

Not sure how to proceed?

Every health problem has its own context. If you are hesitant about what is best for you, arrange a consultation. Our doctors will walk you through the situation and recommend a course of action that makes sense — professionally, sensitively, without unnecessary stress.

Causes and divisions

Cushing's syndrome can be:

  • ACTH-dependent: Cortisol is formed due to increased ACTH production (e.g. Cushing's disease — pituitary adenoma; or ectopic ACTH production in another tumor)
  • ACTH-Independent: The adrenal gland itself forms an excess of cortisol (eg adenoma, carcinoma or bilateral hyperplasia)

In rare cases, the disease can be part of genetic syndromes.

Treatment

The basis of treatment is always elimination of the source of overproduction of cortisol:

  • For adrenal or pituitary adenomas — surgical removal
  • In some cases (e.g., unlocalized ectopic ACTH source) it may be necessary bilateral adrenalectomy
  • In advanced disease — drugs that block cortisol production (e.g. ketoconazole, metyrapone)
  • In aggressive or malignant forms — oncological treatment

Monitoring and long-term care

After surgery, hormone levels need to be monitored and cortisol substitution adjusted. In some patients, metabolic or psychological changes persist even after cure.

Patients are monitored by our multidisciplinary team — endocrinologist, surgeon, possibly oncologist and psychologist.

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