Cushing’s Disease And Syndrome Disease – The Healing Space Clinic

Cushing's Disease And Syndrome Disease

BASICS

DESCRIPTION

Clinical abnormalities associated with chronic exposure to excessive amounts of cortisol (the major adrenocorticoid). The most frequent cause is prolonged use of exogenous glucocorticoids.

System(s) affected: Endocrine/Metabolic, Musculoskeletal, Skin/Exocrine, Cardiovascular
Genetics:
- Multiple endocrine neoplasia type I
- Carney complex
Incidence/Prevalence in USA: Uncommon
Predominant age: All ages
Predominant sex: Females > Males

SIGNS AND SYMPTOMS

Moon face (facial adiposity)
Increased adipose tissue in neck and trunk
Central weight gain
Emotional lability
Hypertension
Osteoporosis
Purple striae on the skin
Diabetes or glucose intolerance with fasting hyperglycemia and/or glycosuria
Muscle weakness due to loss of muscle mass from increased catabolism
Skeletal growth retardation in children
Easy bruising
Hirsutism

CAUSES

Exogenous glucocorticoids and/or ACTH
Endogenous ACTH-dependent hypercortisolism
- ACTH-secreting pituitary tumor
- Ectopic ACTH production (e.g., small-cell carcinoma of lung, bronchial carcinoid)
Endogenous ACTH-independent hypercortisolism
- Adrenal adenoma
- Adrenal carcinoma
- Macro/micro nodular hyperplasia

RISK FACTORS

Any medical problem requiring prolonged use of corticosteroids
Pituitary tumor
Adrenal mass
Neuroendocrine tumor (e.g., bronchial carcinoid)

DIAGNOSIS

LABORATORY

24 hour urinary cortisol
Plasma cortisol (am and pm)
Plasma ACTH concentration
Glycosuria (possible)
Neutrophilia
Lymphopenia
Hyperglycemia
Hyperlipidemia
Hypokalemia
Dynamic endocrine testing (e.g., dexamethasone suppression test)

Drugs that may alter lab results: Refer to lab test or drug reference
Disorders that may alter lab results: Refer to lab test reference

PATHOLOGICAL FINDINGS

Hyalinization of basophilic cells (anterior pituitary) - Crooke's cell changes
Muscular atrophy
Nephrosclerosis

SPECIAL TESTS

If ACTH-dependent, inferior petrosal sinus sampling for ACTH

IMAGING

Chest films
X-rays of the lumbar spine - osteoporosis is common
If pituitary tumor suspected - pituitary MRI scan
If adrenal disease suspected - abdominal CT scan
If ectopic ACTH-secretion suspected - chest CT scan

DIAGNOSTIC PROCEDURES

Not all tests indicated for every case. Choice of diagnostic procedure dependent on circumstances and judgment.

TREATMENT

APPROPRIATE HEALTH CARE

Inpatient for surgical procedures

GENERAL MEASURES

Depends on etiology. Surgery is the treatment of choice; persistent disease may require - radiation, drug therapy, or surgery/li>
Medical treatment with adrenocortical inhibitors
- Has not been too successful
- Should be used when other methods fail
- In consultation with a clinician having experience in their use

SURGICAL MEASURES

Primary hypersecretion of ACTH
- Transsphenoidal microsurgery. Bilateral adrenalectomy as an adjunct for patients not cured.
Adrenocortical tumors
- Surgical removal when possible
- If adrenocortical carcinoma, prognosis is poor
Ectopic ACTH production
- Removal of the neoplastic tissue
- Metastatic spread makes surgical cure unlikely/impossible
- Bilateral adrenalectomy

ACTIVITY

Determined by patient's symptoms and form of treatment used

DIET

Potassium supplements
High protein diet

PATIENT EDUCATION

National Adrenal Disease Foundation (NADF), 505 Northern Blvd, Great Neck, NY 11021; 516-407-4992; e-mail: nadf@aol.com
Instructions on drug therapy, diet, activity
Early treatment of infections
Monitor weight daily
Emotional lability prevention

FOLLOW UP

PREVENTION/AVOIDANCE

Avoid excessive corticosteroid treatment when possible
Comprehensive teaching to help patient cope with lifelong treatment (if needed)

POSSIBLE COMPLICATIONS

Osteoporosis
Increased susceptibility to infections
Hirsutism
Metastases of malignant tumors

EXPECTED COURSE AND PROGNOSIS

Usual course - chronic with cyclic exacerbations and rare remissions
Guardedly favorable prognosis with surgery

MISCELLANEOUS

ASSOCIATED CONDITIONS

Tumors of the pituitary; multiple endocrine neoplasia Type I, Carney complex

AGE-RELATED FACTORS

Pediatric: Rare in infancy and childhood. Most cases (under age 8) are due to malignant adrenal tumors.
Geriatric: N/A
Others: N/A

PREGNANCY

Can cause exacerbation of Cushing's disease

OTHER NOTES

Pituitary ACTH excess due to a pituitary tumor causes what is called Cushing's disease

ABBREVIATIONS

CRH = corticotropin releasing hormone

Clinical Investigations

ROLE OF HOMOEOPATHY

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