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Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome.

Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome.

Cushing's syndrome, also known as hypercorticosteroidism, occurs when a person's tissues are exposed to too much of hormone cortisol.

When adrenal glands release right amount of cortisol, it helps regulate blood pressure, energy production, ability to fight disease, and how body maintains itself and responds to stress. But too much cortisol can change normal function of these processes, leading to symptoms of Cushing's syndrome.

Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome. cause

The body produces too much cortisol. When pituitary and adrenal glands are not working properly, they produce too much cortisol. Reasons for this:

Adrenal growths, which may or may not be cancerous, cause adrenal glands to secrete extra cortisol.

  • Use of exogenous steroids. Steroid hormone therapy has long been used to treat another condition or illness, such as steroid use for anti-inflammatory arthritis.
  • Endogenous: tumor of adrenal cortex:

    • A non-cancerous tumor of pituitary gland that produces large amounts of adrenocorticotropic hormone (ACTH). This, in turn, encourages adrenal glands to produce too much cortisol. This form of Cushing's syndrome is called Cushing's disease. Cancer of Adrenal Cortex Certain cancers elsewhere in body can produce ACTH, causing adrenal glands to produce extra cortisol. ACTH-secreting pituitary adenomas and nonpituitary tumors produce ectopic ACTH.

    Clinical suspicion

    High blood pressure (especially in young people), diabetes and overweight (central type), especially if:

  • Proximal muscle weakness.
  • Pigment lines
    • Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome. Symptoms and signs

    Cushing's syndrome is rare. Between 2 and 5 new cases per million people are diagnosed each year, 10% of which occur in children and adolescents.

    Symptoms include

  • Weight gain, especially of torso and face, as well as preservation of limbs, a "moon" face.
  • Excessive sweating
  • Thin skin that easily bruises, purple streaks on torso and legs.
  • Proximal muscle weakness (thigh, shoulder),
  • Hirsutism.
  • Excess cortisol can also affect other endocrine axes and cause, for example, reduced libido, impotence, and infertility.
  • Patients often suffer from various psychological disorders.
    • Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome.

    Flags include

  • Persistent arterial hypertension
  • Impaired ability to regulate glucose levels (typical of hyperglycemia, often in overt diabetes)

    • Most children and adolescents with Cushing's syndrome show the following symptoms:

  • Severe weight gain
  • Stunting
  • Girls absent from school
  • Excessive hair growth.
  • Acne
  • Skin with red and blue stripes
  • High blood pressure
  • Fatigue and weakness
  • Early or late puberty.
    • Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome.

    Adults with this condition may also experience symptoms of dramatic weight gain, excessive hair growth, high blood pressure, and skin problems. In addition, they may indicate:

  • Weakness of musculoskeletal system
  • Emotional, irritable, or depressed.
  • Sleep disorder
  • High blood sugar
  • Irregular menstruation in women and reduced fertility in men
    • diagnostics

    The doctor reviews patient's medical records and performs a physical examination. If these findings are indicative of Cushing's syndrome, additional tests will need to be performed. The final diagnoses include:

  • Check if you have too much cortisol.
  • Find out cause of high cortisol levels. A urine test measures how much cortisol is produced. If levels indicate Cushing's syndrome, doctor will order other tests to determine cause. These measures may include: Biochemical tests. The dexamethasone suppression test involves oral administration of artificial cortisol over several days and measurement of cortisol levels in blood and urine. The CRH stimulation test involves an injection of corticotropin-releasing hormone (CRH) followed by a blood test to see if ACTH and cortisol levels are elevated. scanning. This may include computed tomography (CT) and magnetic resonance imaging (MRI) of pituitary and adrenal glands, chest and abdomen, ultrasound of adrenal glands, chest x-ray, and possibly a radioisotope test called an iodocholesterol scan. catheterization procedure. A sample of blood coming out of pituitary gland is tested to see if pituitary gland is causing high levels of ACTH.
    • Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome.

    Confirm diagnosis using one of following methods.

  • Daily urinary cortisol
  • Dexamethasone overnight suppression test.
  • Other screening tests include a cortisol circadian rhythm test and a low-dose dexamethasone suppression test, but hospitalization is required.

    • The high-dose dexamethasone suppression test suppresses Cushing's disease but not other causes after confirmation by one of above tests. Plasma ACTH levels determine whether ACTH plays a role in pathogenesis. CT or MRI of pituitary or adrenal glands to look for adenomas. A chest x-ray is necessary to rule out bronchial carcinoma or carcinoid.

    Note: Cushing's disease refers to hypercorticosteroids secondary to ACTH-secreting pituitary adenomas.

    treatment

    Regardless of its underlying cause, cortisol hypersecretion should be controlled prior to surgery or radiation therapy to reduce morbidity and mortality in patients who are not ready for surgery.

    If an adrenal adenoma is found, it can be surgically removed. Steroid replacement therapy is required in most patients in postoperative period, at least in medium term, because long-term suppression of pituitary ACTH and normal adrenal tissue cannot be restored immediately. Obviously, if both adrenal glands are removed, replacement with hydrocortisone or prednisolone is necessary.

    Full moon face, buffalo back, hirsutism, and acne are all clinical manifestations of Cushing's syndrome.

    In those patients who are unsuitable or unwilling to undergo surgery, several drugs have been found to inhibit cortisol synthesis (eg, ketoconazole, meladone) but have limited efficacy. In iatrogenic Cushing's syndrome, a dose adjustment may be sufficient or a change to a different type of immunosuppressant may be required.

    Meravon is drug of choice. The average level of plasma cortisol during day should decrease to 11-15 mcg / l. Alternatively, ketoconazole or aminomethylacetamide can be used.

    The definitive treatment is resection of source of hypersecretion, be it pituitary gland, adrenal gland, or ectopia.

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