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Cushing's syndrome

Cushing's syndrome or Cushing's disease is a hormonal disorder that typically affects adults in the age group 20 - 50 years. This disease is named after the American surgeon Harvey Cushing. Since Cushing's syndrome is characterized by high levels of cortisol in the body, it is also known as 'hypercortisolism'. Cortisol is one of the hormones produced by the adrenal glands and plays a vital role in regulating blood pressure and maintaining the functioning of the cardiovascular system. Cortisol aids the metabolization of proteins and fats and helps the body's response to stress. Adenomas in the pituitary are responsible for Cushing's syndrome. This is more likely in women. Adrenal tumors are sometimes responsible for increased levels of cortisol in the blood.


Typical symptoms of Cushings syndrome include upper body obesity and thinning limbs. Reduced growth rate is noticed among children suffering from Cushing's syndrome. the skin becomes fragile and easily prone to bruising. The patient will notice purple stretch marks around the abdomen, thighs and arms. Persons suffering from Cushing's syndrome tend to experience severe fatigue, weakness in the muscles and elevated levels of blood pressure and blood sugar. There is extra hair growth on the face, chest and abdomen. A person suffering from Cushing's syndrome may suffer from depression and anxiety. Women may notice irregular or cessation of menstrual cycle. There is decrease in libido in men and women. Excessive cortisol produces a characteristic hump of fat between the shoulders. High doses of corticosteroids taken over a prolonged period can trigger Cushing's syndrome.


If left untreated, Cushing's syndrome is usually fatal. Blood and urine tests help in identifying high cortisol levels. A urine test measures how much cortisol is being produced. It is also essential to identify the cause and location of the abnormality that releases excessive cortisol. Biochemistry tests such as dexamethasone suppression test and corticotropin-releasing hormone (CRH) stimulation test also help in testing for Cushing's syndrome. MRI scans aid in locating tumors that may be the cause for Cushings disease. Treatment for Cushing's syndrome can range from radiation and chemotherapy to surgery to remove tumors. Use of cortisol-inhibiting drugs may also be resorted to.

Amenorrhea

Amenorrhea is a condition where a woman of reproductive age does not get her regular menstrual periods. Amenorrhea can be primary or secondary Amenorrhea.

Primary Amenorrhea: This condition occurs when the first menstrual period of a girl is delayed or does begin by 16 years. This could be due to delay in pubertal development. Birth defects in the reproductive system can often lead to primary Amenorrhea as also tumor in the hypothalamus or pituitary gland. Abnormal chromosome or genetic defects can be a cause. Hypothyroidism, hyperthyroidism, Cushing's disease and congenital heart disease can be a cause for primary Amenorrhea. Often the cause is not known. Symptoms include acne and excess body hair, headaches and vision problems.

Secondary Amenorrhea: This kind of Amenorrhea occurs in women during their reproductive period. Secondary Amenorrhea is a situation where the menstrual period is absent for about 3 months. This is most often due to pregnancy and breastfeeding. Symptoms of secondary Amenorrhea are mood fluctuations, goiter, vaginal dryness, depression and nausea.

If any systemic condition is the cause for Amenorrhea, appropriate treatment often leads to the start of menstruation. Often anorexia or over exercising can lead to Amenorrhea. Endocrine disorders, hormonal imbalance, PCOS and use of birth control pills often lead to Amenorrhea. Other causes for Amenorrhea include malfunctioning ovaries and stress. Women who complain of Amenorrhea are given a physical examination by the gynecologist. Blood tests for prolactin and T3, T4 and FSH are done. Other blood tests include test for serum progesterone. Pelvic ultrasound is done to check for any abnormalities.



Neutrophilia

High levels of neutrophil in the blood results in neutrophilia; neutrophils are White Blood Cells or WBC that are assigned the task of killing/fighting off foreign matter like fungi and bacteria in the body. They are an important part of the body's defense force. An adequate amount of production and distribution of neutrophils is very important. However during an infection in the body, an elevated level of neutrophils can be found, with equal numbers in marginal and circulating pool.


The site of infection generates chemotactic agents and attracts neutrophils to the affected part. During recovery the flow of cells decreases from the marrow and this in turn decreases the amount of neutrophils. Neutrophilia is the most common form of leukocytosis - a condition wherein the blood has an increased number of leukocytes. When the cells shift from the marginal to circulating pool without an increase in the total blood granulocyte pool or if there is an increase in size of the TGBP, it could result in Neutrophilia.


Women in their childbearing age have a higher neutrophil count when compared to men. Pregnancy also leads to high neutrophil count and this may tend to increase during childbirth.


Neutrophilia occurrence

True Neutrophilia: True Neutrophilia occurs in most cases of infection and total blood granulocyte pool, the TGBP, may increase 5-6 times the normal level. At the onset of the infection, Neutrophilia count decreases and then it rises to very high levels.

Shift Neutrophilia: Shift Neutrophilia as the name indicates is transient (e.g. during heavy exercise) and may occur in association to other conditions. The change in numbers may last only for a few minutes. There is no change in the inflow of neutrophils from the bone marrow.


Causes for Neutrophilia

Neutrophilia is caused due to increase in bone marrow output or redistribution of white cells. Though there are numerous possibilities for an elevated level of neutrophils in the blood, the most common causes include:


  • Infections, caused by cocci, certain fungi, bacteria (local or generalized), viruses (chickenpox, herpes simplex) and parasites (hepatic amebiasis, Pneumocystis carinii) lead to Neutrophilia

  • Non-infectious inflammation like burns, post surgery, acute attack of gout, asthma, rheumatic fever, autoimmune conditions, any kind of trauma, tissue damage, myocardial infarction can also lead to Neutrophilia
  • Acute and sudden hemorrhage can lead to inflammation and thus lead to Neutrophilia.

  • Poisoning from sources like mercury, lead, digitalis, camphor, quinidine and certain insects can also lead to Neutrophilia

  • Metabolic changes in the body like diabetic ketoacidosis, uremia, etc can cause Neutrophilia

  • Malignancies and other kinds of spreading cancer, where the tumor outgrows the blood supply can lead to neutrophilia

  • Physiologic Neutrophilia is also caused by heavy exercise, epinephrine injections, etc

  • Other causes for Neutrophilia could include seizures, anemia, increase or decrease in platelet count, short or long term usage of corticosteroids, Cushing disease etc

  • Cigarette smoking can cause inflammation and thus lead to Neutrophilia.

  • High levels of stress can also lead to increase in levels of neutrophils and thus cause Neutrophilia.

  • Neutrophilia may be present without any particular cause that can be identified, this type of neutrophilia is called chronic idiopathic neutrophilia.

Diagnosis

Most often neutrophilia is a reactive phenomenon and can be diagnosed through blood tests. A physical examination is done and the medical history of the patient is studied. A complete blood count investigation and a series of blood tests are ordered for. In a few cases bone marrow aspiration is ordered for. The commons symptoms reported include decreased body temperature or hypothermia, dyspnea (labored breathing) or tachypnea (rapid breathing) and sometimes bleeding.


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Bibliography / Reference

Collection of Pages - Last revised Date: August 21, 2019