Cushings disease – causes, symptoms, diagnosis, treatment

What is Cushing’s disease?

Excess release of ACTH hormone from the pituitary gland (gland of the endocrine system located just beneath hypothalamus) causes a condition named as Cushing disease.

Discovery

In 1912, Dr. Harvey Cushing observed the signs of Cushing disease in a girl. In 1932, he found that this disease is due to the high level of cortisol which in turn is due to some irregularity in the pituitary gland. Harvey Cushing is the first to describe this disease.

Types of Cushings disease

There are two types of Cushing disease which is as follows:

  • ACTH independent disease
  • ACTH dependent disease

ACTH independent disease

The condition in which the adrenal gland is more active than normal or due to production of some tumor in adrenal gland cortisol is produced in large amounts 30%. Cushing disease is caused due to adrenal tumors.

ACTH-dependent disease

The condition in which the ACTH is produced in excess amounts due to a small tumor. Pituitary Adenomas are the most common cause of Cushing syndrome and 70% of cases make ectopic ACTH producing tumors.

What are Causes of Cushings disease

Cushing’s disease can be caused due to a tumor or overgrowth of the pituitary gland. The most common tumor of the pituitary gland which causes Cushing disease is adenoma. In normal condition, the cortisol is only released in a stress situation. The use of fats, proteins and carbohydrates in the body is controlled by this cortisol hormone. Excess amount of Cortisol decreases the response of the immune system to inflammation.

  • Cushing disease is a rare disease which is due to large secretion of cortisol hormone in the body. Cortisol is a hormone that is released from adrenal glands and helps the people to respond in stressful conditions such as hunger or cold. In the early morning, cortisol is produced in large amounts and less at night.
  • Due to the large production of cortisol in the body it is called Cushing disease.
  • Cushing disease is caused due to tumor or abnormal growth of the pituitary gland. The most common tumor of the pituitary gland which causes Cushing disease is adenoma. An adenoma is not a cancerous tumor but a benign tumor.
  • In the presence of this tumor pituitary tent to release excess amounts of ACTH. This ACTH is involved in the stimulation of a stress hormone called cortisol. This cortisol is released from the adrenal gland. When adenoma tumor formed in the pituitary causes excess production of ACTH then this ACTH stimulates the cortisol production in large amounts.
  • In normal condition, the cortisol is only released in a stress situation. The use of fats, proteins and carbohydrates in the body is controlled by this cortisol hormone. Excess amount of Cortisol decreases the response of the immune system to inflammation.

Symptoms of Cushings disease

The Cushing disease symptoms are as follows as:

  • In children the growth rate is slow.
  • Obesity in the upper portion of the body.
  • Thinner legs and arms.
  • Moon face.
  • It causes some changes in the skin which may be acne, striae on abdomen skin, upper arm, thighs and breast.
  • Infections of skin.
  • Cause abnormality in the menstrual periods.
  • Loss of hair \or dry hair.
  • In rare cases, it causes low levels of calcium.
  • Excess amounts of cortisol can influence other endocrine systems and may cause wakefulness.
  • It also causes increased production in urination.
  • If Cushing disease is not treated then it causes heart-related problems.
  • Osteoporosis is also caused due to this because bone formation activity is decreased.
  • Also, Cushing disease may cause acute aching in joints especially in hip joints and shoulders joints.
  • Weight has increased rapidly.
  • The immune system is suppressed.
  • Cause memory dysfunction.

Complications

If Cushing disease isn’t treated well then it may lead to the following complications:

  • High blood pressure
  • Diabetes type 2
  • Frequent or unusual infections
  • Bone loss may occur such as rib fractures or fracture in any bone
  • In this muscle mass and strength are loss
  • Cholesterol is produced in the body is not healthy

How to Diagnosis Cushings disease

The diagnosis of this disease is a very difficult process because confirmatory tests are needed at every step. The diagnosis is based on the medical history of the patient, bodily exams and different tests. The tests include the blood test, urine test and saliva test.

Salivary test

The diagnosis is begun with a salivary cortisol test to check hypercortisolemia. Its diagnosis involves many tests of salivary cortisol level. Late at night, the level of cortisol is low in the normal person. In the salivary test, the saliva of the patient at night is collected and directed to the laboratory to check the level of cortisol. If the cortisol level is high then Cushing disease is diagnosed in that patient.

Urinary test

This test is conducted to observe the level of cortisol in the urine of the patient. The urine of the patient is collected and directed to the laboratory. If the level of cortisol is high in the urine then the person has Cushing disease.

Dexamethasone suppression test

Dexamethasone suppression test is also performed with a low dose. A Dexamethasone is a form of Glucocorticoids. The patient takes a little amount of Dexamethasone at night and then the blood test of the patient is conducted in the morning.

In normal persons, the level of cortisol becomes low after the dose of Dexamethasone. If the report of this blood test does not show the low level of cortisol, then the patient has Cushing disease. If this report diagnoses the Cushing disease in the patient, then further tests are taken.

CRH stimulation test

After the two days Dexamethasone test, a CRH stimulation test is also conducted. When Cushing disease is detected in a person then it is compulsory to know the causes of excess amount of cortisol. It is found that some people have the pseudo-Cushing disease, a condition in which people have high levels of cortisol up and down but they do not have long term effects on health.

This condition is due to obesity, diabetes, drinking alcohol and depression. The hypothalamus releases the GRH which says the pituitary to release the ACTH. This ACTH says the adrenals secrete the cortisol hormone.

In this test, the level of cortisol is observed and then gives a dose of Dexamethasone to the patient. If the level of cortisol and ACTH does not rise after the dose of Dexamethasone then the patient has pseudo-Cushing disease and if the levels of ACTH and cortisol are raised the patient has Cushing disease.

ACTH test

The level of ACTH is measured to find the cause of Cushing disease. If the level of ACTH is low then the Cushing disease is due to the tumor in the adrenal gland. And if the ACTH level is high or normal then the Cushing disease is due to the pituitary tumor.

CT scan and MRI

CT scan and MRI tests are conducted to measure the size of tumors including the pituitary and adrenal tumors.

What are Treatment options of Cushings disease

The treatment of the Cushing disease is based on the cause of the disease. The objective of the treatment is to control the raised level of cortisol in the blood. The treatment of Cushing disease includes the following methods:

  •         Medical therapy
  •         Surgical therapy
  •         Radiotherapy

Medical therapy

Medicines are given to the patients of Cushing’s disease to maintain the level of cortisol and also before the surgical therapy to reduce the risk of surgery. The following medicines are suggested to the patients:

  • Ketoconazole
  • Mitotane
  • Metyrapone

The ketoconazole decreases the level of cortisol in the blood. Mitotane kills the cancerous cells of the adrenal and also lowers the production of hormones from the adrenal. Metyrapone inhibits the synthesis of cortisol from the adrenal. If adenoma tumor of the pituitary gland does not show any response to surgery as well as radiation then the patient requires medical treatment for stopping the cortisol production in the body.

Surgical therapy

If the Cushing disease is due to the tumor, then the surgical therapy is suggested to the patient. The tumor may be in the pituitary or adrenal. After the removal of the tumor from the pituitary, the pituitary slowly returns to its normal functioning.

Neurosurgeons remove the tumor through the nose with the help of a microscope. Before the surgery medicines are given to the patient to lower the size of the tumor. And also, after the surgery medicines are suggested by the doctors that the body maintains the levels of cortisol accurately. 

Radiotherapy

If surgery fails to remove the tumor completely from the pituitary gland, then the remaining tumor cells are removed by radiation treatment. Radiotherapy is also suggested by the doctors if the physical condition of the patient is not suitable for the surgery. Different procedures of radiotherapy are used.

In stereotactic radiotherapy, the small doses of radiation fall on the tumor within a one and half month. In the other procedure, a large dose of radiation is given only at once. In the second procedure, there is a lower risk for the neighboring tissues to damage.

Homeopathic treatment of Cushings disease

The following medicines are suggested to the patients of Cushing’s disease in the homeopathic treatment:

  • Quercus Robur
  • Arsenic Album
  • Adrenaline
  • Mercurius Solubilize
  • Pituita rum Poterium
  • Chelidonium Majus
  • Sulfur

Due to the Cushing disease, the mental responsiveness is also affected to control this Quercus Robur is given to the patients of Cushing disease. It also prevents the accumulation of fluids in the abdomen.

Due to the accumulation of fluids in the abdomen, the swelling in the abdomen occurs. If the cause of the Cushing disease is the over secretion of cortisol due to the adrenal tumor the adrenaline is given to the patients of Cushing disease.

The adrenaline helps to maintain the level of adrenal secretions. The treatment of the Cushing disease with the homeopathic medical therapy depends on the cause of the disease and the complications within the Cushing disease.

Side effects of treatment

The side effects of the above treatments include:

  • Headache
  • Vomiting
  • Nausea
  • Diarrhea
  • High blood pressure
  • Diabetes
  • Abdominal pain
  • Fatigue

Life expectancy in Cushing’s disease patient:

The Cushing disease is not fatal but if it is not treated properly then it leads to the many serious complications. These complications become very dangerous for the patient and lead the patient to death.

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