Cushing's Syndrome

"Except for cases due to steroid use, Cushing's syndrome is a rare disease that affects 10 people per million inhabitants per year".

DR. CAMILO SILVA FROJÁN
SPECIALIST. ENDOCRINOLOGY AND NUTRITION DEPARTMENT

Cushing's syndrome occurs when the adrenal cortex becomes overactive and increases cortisol production.

It may be due to an autonomic hypersecretion of the adrenal cortex due in most cases to an adenoma and more exceptionally to a carcinoma.

However, the most frequent cause of "Cushing's syndrome" is hypersecretion of ACTH, which in 85% of cases is due to an ACTH-producing pituitary adenoma. Excess ACTH from a carcinoid or lung tumor, or ectopic ACTH secretion syndrome, is much rarer.

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What are the symptoms of Cushing's syndrome?

The "Cushing's syndrome" is characterized by full moon face, centrally distributed obesity affecting face, neck and abdomen, muscular atrophy of extremities, high blood pressure, diabetes mellitus, osteoporosis, nephritic colic and capillary fragility that produces frequent bruising.

When the cause is a pituitary adenoma, it can additionally lead to headache and vision alterations if there is compression of the optic chiasm.

The most common symptoms are:

  • Full moon face.
  • Centrally distributed obesity.
  • Muscular atrophy of extremities.
  • Arterial hypertension.

Do you have any of these symptoms?

You may have Cushing's syndrome

How is Cushing's syndrome diagnosed?

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The diagnosis of function is made by analytical determinations in blood and urine.

In "Cushing's syndrome", a lack of circadian cortisol rhythm in the blood and elevated urinary cortisol are typical. The filiation of the origin is carried out by the determination of ACTH, suppression of cortisol with dexamethasone and CRH test.

In cases of "Cushing's syndrome" with elevated ACTH, a pituitary MRI should be performed to locate the ACTH-producing adenoma.

If it is not visualized, a lower petrosal sinus catheterization may be necessary to confirm that the origin of the increased ACTH secretion is in the pituitary gland.

How is Cushing's syndrome treated?

When there is hormonal hypersecretion it is necessary to antagonize its effects as a first therapeutic measure.

In the case of "Cushing's syndrome", ketoconazole is used, which is an antifungal drug (used to treat fungal infections) that reduces the synthesis of cortisol in the fasciculated layer.
 
If the "Cushing's syndrome" is due to ACTH-producing pituitary adenoma, it has to be removed, usually by transsphenoidal route (through the sphenoid bone, at the base of the skull), if its size allows it.

Patients with "Cushing's syndrome" due to chronic treatment with steroids should progressively reduce the dose of these if their clinical condition allows it.

In these cases and in people with "Addison's disease", the need to administer supplementary doses of steroids should be considered when there are intercurrent processes (surgical interventions, infections).

Where do we treat it?

IN NAVARRA AND MADRID

The Department of Endocrinology and Nutrition of the
of the Clínica Universidad de Navarra

The Department is organized into care units with specialists totally dedicated to the study, diagnosis and treatment of this type of disease.

We work with established protocols, which ensure that all diagnostic tests to be performed are done in the shortest time possible and that the most appropriate treatment is started as soon as possible in each case.

Organized in care units

  • Obesity Area.
  • Diabetes Unit.
  • Thyroid and Parathyroid Disease Unit.
  • Osteoporosis Unit
  • Other diseases: e.g. Cushing's syndrome.
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Why at the Clinica?

  • European Center of Excellence in the diagnosis and treatment of Obesity.
  • Team of specialized nurses at the Day Hospital of Endocrinology and Nutrition.
  • We have a Metabolic Research Laboratory of international prestige.

Our team of professionals

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