What is Cushing's Syndrome? What is the test or treatment?

 

Cushing's syndrome is a disease in which clinical symptoms such as high blood pressure, abnormal glucose tolerance (diabetes), osteoporosis, menstrual irregularity, depression, and weight gain occur due to excessive secretion of a hormone called cortisol secreted by the adrenal glands. Among the hormones secreted by the adrenal glands, the most important is known as cortisol, and cortisol has a role to support all vital functions. Cortisol is a very delicate hormone that affects the body, whether too little or too much. This time, let's learn more about the symptoms and treatment of Cushing's syndrome.

What is Cushing's Syndrome?

What are the symptoms of Cushing's syndrome?

There are many characteristic symptoms of Cushing's syndrome, including the following:

• Full moon face that is round due to fat on the face
• bison shoulder
• Central obesity with fat accumulation in the body and skinny limbs
• Skin becomes thin
• decrease in muscle strength

The biggest characteristic of the physical symptoms is that fat tends to stick to the chin, face, shoulders, and back, and on the contrary, the muscles of the hands and feet become weak and thin. In addition, clinical symptoms such as high blood pressure, abnormal glucose tolerance (diabetes), osteoporosis, and menstrual abnormalities may appear, making it a judgment material for diagnosing Cushing's syndrome. If there are only clinical symptoms, Cushing's syndrome is not well diagnosed, and whether there are physical symptoms is important.

What causes Cushing's syndrome?

Cushing's syndrome is caused by excessive secretion of cortisol, which is often caused by an adrenal cortical adenoma, a tumor in the adrenal cortex, or a tumor in the pituitary gland of the brain. Rarely, cancer of the adrenal glands is the cause. Cushing's syndrome is classified according to the disease state as follows:

• Adrenal Cushing's syndrome, an increase in cortisol due to abnormalities in the adrenal glands
• ATCH-dependent Cushing's syndrome in which adrenocorticotropic hormone (ATCH) is over-secreted and cortisol is increased due to a pituitary tumor, etc.
• Medicinal Cushing's syndrome, in which cortisol excess symptoms are caused by the use of drugs that act like cortisol

The risk of getting Cushing's syndrome... ?

Cushing's syndrome is a disease caused by excessive secretion of the steroid hormone cortisol. Cortisol promotes metabolism of nutrients needed by humans, such as sugar, fat, and protein, and also suppresses inflammation and suppresses immune function. Cortisol is an essential hormone for human life. However, cortisol also has effects such as bone resorption, promoting gastric acid secretion, and abnormal lipid metabolism, which can cause various complications. It is easy to get diabetes or osteoporosis due to elevated blood sugar, and as the disease progresses, the possibility of pathological fractures, stroke and angina pectoris due to the effects of high blood pressure or hyperlipidemia increases. And if it becomes more severe, immunity is lowered and it is easy to get an infectious disease, and there is a risk of sepsis. It is known that if Cushing's syndrome causes these complications, the mortality rate is several times that of normal people.

Are there any characteristics of a person who is easy to become?

Cushing's syndrome is more common in women in their 30s to 50s, and the male to female ratio is known to be 1:4. People who are using large amounts of corticosteroids for severe asthma, etc. are prone to drug Cushing's syndrome. This is because corticosteroids are in a state where too much of the hormone is being made.

I heard it's inherited...

It is generally known that it is not inherited, but familial Cushing's syndrome is rare, and there are papers that found a genetic mutation that causes ATCH-independent Cushing's syndrome.

How is Cushing's syndrome tested?

What tests are done for Cushing's syndrome?

First, a blood test tests the level of cortisol or adrenocorticotropic hormone called ATCH in the blood, in some cases, a urine test to check the amount of cortisol, or imaging tests such as an abdominal CT may be done. And the 'dexamethasone inhibition test' is a test that can check the blood level of cortisol in more detail.

Please provide more details about the main inspection content.

The dexamethasone inhibition test is a test that examines changes in cortisol and ACTH values ​​by taking a drug called dexamethasone (dexamethasone) orally. ACTH secreted by the pituitary gland sends a command to the adrenal glands and cortisol is produced. When dexamethasone, which has the same effect as cortisol, is taken orally, the body judges that the amount of cortisol is sufficient and cannot send commands from ACTH to the adrenal glands. If it is normal, taking dexamethasone will lower the production of cortisol. The case of Cushing's syndrome is different. In Cushing's syndrome, the decrease in blood cortisol levels due to the administration of large amounts of dexamethasone is the cause of brain tumors (Cushing's disease). The values ​​of cortisol continue to be high. This test can make a definitive diagnosis of whether you have Cushing's syndrome or not.

How long does the test take?

In the case of only a blood test or urine test, the test does not take much time and the test results are often immediately available. However, when conducting a dexamethasone inhibition test, it usually takes 1 to 2 days because dexamethasone is taken orally the night before and several blood tests are performed the next day. Also, the dexamethasone inhibition test takes about a week to get results.

Treatments Used for Cushing's Syndrome

What is the main treatment for Cushing's syndrome?

For those with adrenal tumors, radical treatment is possible by surgically removing the tumor that is the cause. In cases where surgery is difficult for various reasons or if the tumor cannot be completely removed, radiation therapy or drug therapy is sometimes performed.

Are there any side effects from treatment?

After tumor excision, the amount of cortisol temporarily decreases, but it returns to normal in about half a year to a year or two years. Although the physical symptoms gradually disappear, bone density, which has been reduced due to the bone resorption action of cortisol, does not return to normal, so continuous osteoporosis treatment may be required.

Please tell me if there are any precautions to be taken during or after treatment.

After treatment, the secretion of cortisol temporarily decreases, so until the amount of cortisol is stabilized, treatment such as supplementing with oral medications may be necessary. If there is only one adrenal tumor, the other adrenal gland remains intact, so if the cortisol secretion is stable, you can stop taking the drug, but if there are tumors in both adrenal glands, you should continue to take it internally. It is important to follow the doctor's instructions, as the treatment contents and post-treatment precautions vary depending on the condition.

Cushing's syndrome is a disease that is easy to appear in appearance changes because there are many characteristic physical symptoms. In particular, fat accumulation on the face, shoulders, and back is also a symptom that is easy to notice even on your own. If you feel any abnormality, consult your doctor as soon as possible. If left untreated, it can lead to various complications and in some cases even life-threatening.

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In order to detect Cushing's syndrome early, it is necessary to turn to the state of the body and observe whether there is a full moon-shaped face, bison shoulder, and central obesity. Because Cushing's syndrome is a disease that is difficult to prevent because the main cause of its onset is an adrenal tumor or pituitary tumor, early detection and early treatment is more important than trying to prevent it. If excessive secretion of cortisol is left unattended, there is a risk of life as it becomes more susceptible to weakening of immunity, the development of infectious diseases, stroke and ischemic heart disease. 'Recently, my face has become round' 'I can't control blood pressure and blood sugar well' 'My hands and feet are getting thinner, but fat is attached to my trunk' 'I have low bone density for my age' 'I have no strength in my hands or legs' If you experience any physical symptoms such as