April 8th is Cushing's Awareness Day
April 8th is the birthday of Dr Harvey Cushing (1869-1939) who described the disease that goes by his name in 1932: Cushing’s Disease. There is a push to have this day named as the National Cushing’s Awareness Day. For now, it is simply Cushing’s Awareness Day – a day to bring attention to this disease.
Cushing’s syndrome is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. This may be due to the patient taking glucocorticoids - steroid hormones that are chemically similar to naturally produced cortisol - such as prednisone for asthma, rheumatoid arthritis, lupus, and other inflammatory diseases. Glucocorticoids are also used to suppress the immune system after transplantation to keep the body from rejecting the new organ or tissue.
Other people develop Cushing’s syndrome because their bodies produce too much cortisol. This may be due to a tumor on the pituitary gland, the adrenal gland, or elsewhere in the body.
Cushing’s syndrome is thought to be relatively rare, affecting most commonly adults aged 20 to 50. Some of the symptoms of Cushing’s are common in the general population which may lead to delayed or un-diagnosis in many.
People who are obese and have type 2 diabetes, along with poorly controlled blood glucose and high blood pressure, have an increased risk of developing the disorder.
Signs and symptoms of Cushing’s syndrome vary, but most people with the disorder have upper body obesity, a rounded face, increased fat around the neck, and relatively slender arms and legs. Children tend to be obese with slowed growth rates.
Other signs appear in the skin, which becomes fragile and thin, bruises easily, and heals poorly. Purple or pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts. The bones are weakened, and routine activities such as bending, lifting, or rising from a chair may lead to backaches and rib or spinal column fractures.
Women with Cushing’s syndrome usually have excess hair growth on their face, neck, chest, abdomen, and thighs. Their menstrual periods may become irregular or stop. Men may have decreased fertility with diminished or absent desire for sex and, sometimes, erectile dysfunction.
Sometimes other conditions have many of the same signs as Cushing’s syndrome, but without the abnormally elevated cortisol levels. For example, polycystic ovary syndrome can cause menstrual disturbances, weight gain beginning in adolescence, excess hair growth, and impaired insulin action and diabetes. Metabolic syndrome—a combination of problems that includes excess weight around the waist, high blood pressure, abnormal levels of cholesterol and triglycerides in the blood, and insulin resistance—also mimics the symptoms of Cushing’s syndrome.
Diagnosis is based on a review of a person’s medical history, a physical examination, and laboratory tests. X rays of the adrenal or pituitary glands can be useful in locating tumors.
Treatment depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs. If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects. In some cases, noncorticosteroid drugs can be prescribed.