Cushing Syndrome: A Case Study

Cushing’s syndrome is a rare endocrine disorder that occurs when your body is exposed to an overabundance of the hormone cortisol.3 Cortisol is known as the stress hormone. The interruption of cortisol secretion can cause weight gain and can ultimately determine where you put the weight on.8 There are many underlying causes such as Pituitary Adenomas, Ectopic ACTH Syndrome, Adrenal Tumors, and Familial Cushing’s Syndrome.2 The majority of these people affected by this hormonal disorder experience weak muscles, increase fat, high blood pressure, etc.1 Although thousands are affected in various ways, there are currently several channels of treatment administered by medical professionals. Through the use of improving technology, medical professionals are better understanding the disorder, allowing them to develop better treatment practices.

Cushing 's syndrome (CS) is characterized by pathologically elevated free glucocorticoid levels. Endogenous hypercortisolism is usually due to ACTH-secreting pituitary corticotropic adenomas and less often due to ectopic ACTH-secreting neuroendocrine neoplasms or ACTH-independent adrenal cortisol hypersecretion (Yaneva, 2010). Cushing 's disease occurs infrequently in an inherited setting in both of these conditions (Yaneva, 2010).

Cortisol is a glucocorticoid hormone secreted by the fasicularis layer of the adrenal cortex. One of the most common adrenal disorder is Cushing syndrome. Cushing syndrome is caused by elevated ACTH and subsequent excessive cortisol secretion. Major causes of Cushing syndrome involve ACTH-dependent, and ACTH-independent. ACTH-dependent includes ACTH-secreting pituitary adenoma, and ectopic ACTH, while ACTH-independent includes functioning adrenocortical tumor, and exogenous glucocorticoid administration.1 In ACTH-secreting pituitary adenoma, Cushing syndrome is the most common cause of noniatrogenic hypercortisolism accounts for about 60% of the cases. It is more prevalent in women than men with a diagnosed age around 20-40 years old. This

It is important to distinguish between Cushing disease and Cushing syndrome. While both are based on high levels of cortisol circulating in the body, Cushing disease is specifically caused by a generally benign tumor of the pituitary gland which secretes excess levels of adrenocorticotropic hormone (ACTH), leading to overproduction of cortisol in the adrenal glands. Cushing syndrome, on the other hand, refers to the symptoms caused by elevated levels of cortisol in the body due to any cause, and is also called hypercortisolism or hyperadrenocorticism. In addition to the Cushing disease promoting pituitary tumor, a number of additional circumstances may lead to the development of Cushing Syndrome. Elevated levels of cortisol often are a result of a prolonged use of corticosteroids, which may be prescribed for the treatment of allergies, asthma, or autoimmune diseases. However, elevated cortisol levels may also occur with cancerous or benign tumors of the ACTH-producing lungs, pancreas, or thyroid stimulating an excess production of cortisol. Cushing syndrome is fairly rare, affecting 10 -15

1. Cushing's disease is a hormonal disorder which is caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. It is sometimes referred to as hypercortisolism, it is fairly rare and it most commonly affects adults between the ages of 20 to 50. There is an estimated 10 to 15 of every million people who are affected every year.

Obesity is known to contribute to metabolic abnormalities. Findings of this study suggest that obesity also reflects Cushing's through hormonal interaction.

Hashimoto thyroiditis is a common disease caused by hypothyroidism. The immune system cells attack the thyroid gland, causing inflammation and eventually destruction of the gland. This reduces the thyroids ability to make hormones. These hormones are known as thyroxine (T4) and tri-iodothyronine (T3) (Better health channel 2015).

An endocrine disorder, such as hypothyroidism or diabetes. Diabetes is the most common cause of this condition.

In adults, a tumor is the most common cause of too much GH production: Pituitary tumors. Most cases of acromegaly are caused by a noncancerous tumor of the pituitary gland. Secretion of excessive amounts of growth hormone causes the signs and symptoms of acromegaly. Symptoms such as headaches and impaired vision are resultant of the tumor mass pressing on nearby brain tissues.

A summary of the similarities and differences as noted above is as follow: Individuals with hypothyroidism, can experience fatigue, lack of energy, weight gain, hair thinning and loss, cold intolerance, and brittle nails (Lund et al., 2018). Adrenal insufficiency symptoms include fatigue, weakness, brittle nails, and weight loss (NIDDK, 2017). Menopause symptoms can include fatigue, mood changes, weight gain, hot flashes, hair thinning and loss (Lund et al., 2018).

3. As hypothyroidism progresses, symptoms will start to occur including fatigue, weight gain, cold intolerance, peripheral neuropathy, memory loss, sleep apnea, and daytime drowsiness.

Cushings sydrome is characterised by a group of symptoms that occur as a result of elevated levels of cortisol.

The treatment of Cushing’s syndrome can be achieved from different drugs found in different classes. The classes in which these drugs are found is namely; Steroidogenic inhibitors which consists of drugs such as Metyrapone, Ketoconazole, Etomidate, and Aminoglutethimide; Adrenolytic agents which consists of Milotane; Neuromodulators of adrenocorticotropic hormone (ACTH) which consists of Cyproheptadine and Pasireotide; and lastly, Glucocorticoid receptor blocking agents which consist of Mifepristone. Henceforth, these drugs used in the treatment of Cushing’s syndrome will be outlined demonstrating their usefulness in relieving the problem faced by patients with this disease.

Both hypo and hyperthyroidism are a result of a disease in caused by malfunction of the thyroid gland located in the neck as represented by the image below left. The causes of chronic hypothyroidism are fairly distinct. Around the world in third-world and developing countries, iodine deficiency is the most common cause of hypothyroidism. This used to be true as well for developed countries, but today this is a less common cause as iodine usually finds its way into our diets without too much trouble. In modern-day developed countries, hypothyroidism is mainly a result of Hashimoto's thyroiditis, a birth defect which lacks a thyroid gland or a deficiency of hormones from either the hypothalamus or the pituitary gland.

ACTH-independent Cushings Syndrome typically originates from abnormalities of the adrenal gland. Adrenal adenoma and adrenal carcinoma occur when there is a benign or cancerous tumor on the adrenal gland. These tumors can cause over production of cortisol, disrupting homeostasis. Other diseases like Carney complex and McCune Albright syndrome have also been associated with abnormalities of the adrenal gland, causing overproduction of cortisol. A final form of cushings syndrome is exogenous glucocorticoid administration.