Cushing’s disease
What is Cushing’s disease?
Cushing’s disease is a condition in which the pituitary gland produces excessive adrenocorticotropic hormone (ATCH).
What are the causes?
Cushing’s disease is caused by a benign tumor (swelling) of the pituitary gland which secretes ACTH. ACTH stimulates the production and release of cortisol, a stress hormone, secreted from the adrenal gland.
Cortisol is normally released during stressful situations. It controls the body’s use of carbohydrates, fats, and proteins and also helps reduce the immune system’s response to inflammation (swelling).
What are the symptoms?
Symptoms usually include:
- Upper body obesity (above the waist) and thin arms and legs
- Round, red, full face (moon facies)
- Slow growth rate in children (Short stature)
Skin changes often seen in Cushing’s disease are:
- Purple marks (1/2 inch or more wide), called striae, on the skin of the abdomen, thighs, and breasts
- Thin skin with easy bruising
- Acne or skin infections
Muscle and bone changes include:
- Collection of fat between the shoulders (buffalo hump)
- Thinning of the bones, which leads to rib and spine fractures
- Weak muscles
- Backache, which occurs with routine activities
- Bone pain or tenderness
Women often have:
- Excess hair growth on the face, neck, chest, abdomen, and thighs
- Menstrual cycle becomes irregular or stops
Men may have:
- Impotence
- Decreased or no desire for sex
- Decreased fertility
Other symptoms that may occur include:
- Mental changes, such as depression, anxiety, or changes in behavior
- Fatigue
- Headache
- High blood pressure
- Increased thirst and urination
How Adrenal Glands are relevant to our body ?
- Chronic loose stools
- Darkening of the skin color
- Unnaturally dark color in some places
- Paleness
- Extreme weakness, Fatigue, Loss of appetite
- Mouth lesions on the inside of a cheek (buccal mucosa)
- Nausea and vomiting
- Salt craving
- Unintentional weight loss
- Changes in blood pressure or heart rate
How Adrenal Glands are relevant to our body ?
Tests may show :
Other tests may include:
- Abdominal CT scan
- ACTH
How Addison’s disease can be treated?
Steroid replacement will control the symptoms of this disease. However, you will usually need to take these drugs for life. People often receive a combination of glucocorticoids (cortisone or hydrocortisone) and mineralocorticoids (fludrocortisone). More often we come across patients
who stop medications (as they are told by the pharmacy sales persons that steroids have lots of side effects and should not be taken for long time) and land up with various complications.
Steroid medication for this condition should never be skipped because life-threatening reactions may occur.
Sick Day Schedule (Steroid Stress Cover):
Endocrinologist may increase the medication dose in times of stress like:
Infection
Injury
Stress
Usually dosage has to be doubled during any sickness (at least for 2-3 days)
During an extreme form of adrenal insufficiency (adrenal crisis), hydrocortisone must be injected immediately (intravenous/intramuscular).
It is important always to carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency.
How is the prognosis?
When to Contact a Medical Professional ?
Contact your health care provider if:
- Persistent vomiting
- Stressful siyuations such as infection, injury, trauma, or dehydration (dosage adjustment may be needed).
- Undue weight gain
- Ankle swelling (pedal edema).
- Symptoms of adrenal crisis (Abdominal pain, difficulty in breathing, reduced consciousness, low BP)
