CUSHING'S SYNDROME

General Information

DEFINITION--An endocrine disorder caused by excess corticosteroid hormones produced by the adrenal glands.

BODY PARTS INVOLVED--Adrenal gland (located over the kidney); pituitary gland (at the base of the brain).

SEX OR AGE MOST AFFECTED

• All ages, but most common in adults.
• Both sexes, but more common in women.

SIGNS & SYMPTOMS

• Round face and puffy eyes.
• Ruddy red complexion.
• Growth of facial hair in women.
• Fat accumulation over the upper back and trunk, accompanied by red "stretch marks."
• High blood pressure.
• Mental and emotional changes, including psychosis.
• Menstrual changes, including cessation of, increased or irregular periods.
• Enlarged clitoris.
• Low resistance to infection.

CAUSES--

Symptoms and signs result from overproduction of the cortisone-like hormone produced by the adrenal glands. The overproduction may result from:

• A tumor in the adrenal glands.
• A pituitary tumor, causing production of excessive ACTH (adrenocorticotropic-hormone), which the pituitary gland produces to stimulate adrenal glands to secrete hormones.
• Prolonged use of cortisone drugs.

RISK INCREASES WITH--Prolonged use of ACTH for treatment of pituitary cancer.

HOW TO PREVENT--If use of ACTH or cortisone is necessary for other disorders, such as asthma, arthritis, kidney disease or Addison's disease, take the lowest dose possible for the shortest time. Consult your doctor.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms. Pictures taken before symptoms begin are helpful in noting changes in appearance.
• Medical history and physical exam by a doctor.
• Laboratory blood and urine studies of white-blood-cell counts, pituitary and adrenal-gland function and hormone levels.
• X-rays of the pituitary and adrenal glands.

APPROPRIATE HEALTH CARE

• Doctor's treatment, including consultation with an endocrinologist.
• Surgery (sometimes) to remove ACTH-producing tumors from the pituitary or to remove adrenal-gland tumors.
• Hospitalization for high voltage radiation treatment of the pituitary gland (sometimes).

POSSIBLE COMPLICATIONS

• Bone fractures due to osteoporosis.
• Diabetes mellitus.
• Peptic ulcers.
• Osteoporosis.
• Pituitary tumor, if adrenal glands are removed (rare).

PROBABLE OUTCOME--

• If caused by an adrenal-gland tumor, the disorder is curable with surgical removal of the tumor or glands. Lifelong, carefully monitored drug therapy is essential if the glands are removed.
• If caused by a pituitary tumor, the disorder is curable with surgical removal or radiation of the tumor, but tumors may recur.
• If caused by prolonged use of cortisone drugs or ACTH, the condition may improve if these are withdrawn gradually under medical supervision.

How To Treat

GENERAL MEASURES--

• Learn all you can about this condition and its treatment. You must often monitor your own reactions to medications. Discontinuing drugs suddenly is dangerous.
• Wear a Medic-Alert bracelet or pendant (See Glossary).
• Protect yourself from fractures. Accident proof your home. Wear seat belts in autos.

MEDICATION--Your doctor may prescribe:

• Drugs to suppress adrenal-gland function.
• Cortisone drugs, if adrenal glands must be removed surgically.
• Drugs to replace pituitary hormones (sometimes).
• Antihypertensive drugs to lower blood pressure.
• Calcium supplements to treat osteoporosis.
• Sedatives (sometimes).

ACTIVITY--No restrictions. Energy will increase once treatment begins.

DIET--Consult your doctor about possible salt restriction.

Call Your Doctor If

• You have symptoms of Cushing's syndrome.
• Signs of infection occur, such as fever, chills, muscle aches, headache and dizziness.
• There are signs of steroid underdosage (fatigue, weakness, dizziness) or overdosage (swelling in hands or feet, weight gain).