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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.

ACTH Test

ACTH also known as adrenocorticotropic hormone is a hormone produced by the pituitary gland. This hormone in turn regulates the production of another important hormone cortisol, made by adrenal glands. Cortisol, known as a 'stress hormone', controls varied reactions in our body that take place in response to stress. Cortisol regulates blood pressure and blood sugar levels in the body and helps in maintaining immune function and anti-inflammatory processes. ACTH travels through the bloodstream to the adrenal glands and stimulates the adrenals to release cortisol. An ACTH blood test is done to measure the level of the adrenocorticotropic hormone in the blood.


Too much or too little ACTH level reveals problems related to adrenal glands or pituitary glands. High level of ACTH points to problems with adrenal glands and low level of ACTH may imply defective pituitary glands. The results of ACTH test is extremely useful in diagnosing Cushing syndrome and adrenal insufficiency.

Higher values of ACTH test are associated with one of the following conditions:



Lower levels of ACTH could mean adrenal tumor, Exogenous Cushing syndrome or hypopituitarism, a pituitary dysfunction leading to little or no production of hormone.


Preparing for the test

Patient should not eat or drink for 10 hours prior to the test. It is advisable to take a diet low in carbohydrates for two to three days before the test. Exercise and alcohol should be avoided for 12 hours before the test. Few steroid medications result in low levels of ACTH, hence patient should share all the information regarding the current medication with the doctor. Patient should not have undergone any medical test that uses a radioactive tracer for a week before an ACTH test.


ACTH levels do not remain in the same range through the day. The plasma ACTH levels are highest in the morning and start to decline during the waking hours. Therefore, blood is usually collected in the morning hours or multiple blood samples are sought for accurate diagnosis.

The Normal reference range is as follows:

Morning: Less than 80 pg/mL or less than 18 pmol/L

Evening: Less than 50 pg/mL or less than 11 pmol/L

A significant deviation from the normal range could mean defective adrenal glands or pituitary gland and further investigation is ordered for the accurate diagnosis.


Hirsutism

Hirsutism is a condition where a woman has male-pattern hair growth. It results in excessive coarse dark hair where women don't generally have hair, such as the face, chest and back. It can happen due to high androgen levels or increased skin sensitivity to androgens caused due to certain medical conditions. Else it could be traced to ethnicity and genes.


Excessively high androgen levels are most often the cause for Hirsutism. Some signs of virilization might be noticed along with Hirsutism such as acne, balding, deepening voice, enlarged clitoris and reduced breast size. Other causes include:


  • PCOS- Polycystic Ovarian Syndrome

  • Cushing's Syndrome H- or Hypercortisolism as it is known owing to the high levels of cortisol in the body.

  • Tumor

  • Acromegaly - A hormonal disorder that results from excessive secretion of growth hormone.

  • Congenital adrenal hyperplasia

Tackling Hirsutism

Anti-androgens are often prescribed to block the androgen effect thereby reducing the excessive hair growth. The effect is slow as the hair takes about 6 months to get thinner and less noticeable. Oral contraceptives, Finasteride, Spironolactone and Cyproterone are commonly prescribed anti-androgens.

Women resort to waxing and shaving to get rid of unwanted hair. Depilatories and eflornithine cream are also self-care options. Laser treatment or IPL (Intense Pulsed Treatment) are undertaken to destroy the hair root permanently. They are done over several sittings and must be done under qualified practitioners.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 11, 2019