Cushing’s syndrome is a hormonal disorder characterized by the excessive production of cortisol by the adrenal glands. This rare condition can be identified by symptoms such as purple stretch marks and a fatty accumulation between the shoulders. In a discussion with HT Lifestyle, Dr. Pranav A Ghody, an endocrinologist at Wockhardt Hospital in Mumbai Central, elaborated on the relationship between cortisol and Cushing’s syndrome. 

Dr. Ghody stated, "Cortisol influences nearly every organ in the body; it plays a crucial role in regulating blood pressure, blood sugar levels, energy metabolism, and controlling inflammation. Often referred to as the stress hormone, cortisol is produced in greater amounts by the adrenal glands in response to stress. Prolonged elevated levels of cortisol can lead to the intricate disorder known as Cushing’s syndrome."

Cushing syndrome: Types

Exogenous: The condition known as exogenous Cushing’s syndrome arises when the body is subjected to an excessive amount of cortisol from external sources. This variant is the most prevalent form of Cushing’s syndrome and is frequently associated with the use of steroids to manage various medical conditions, including rheumatoid arthritis, asthma, lupus, and joint disorders, as well as to prevent transplant rejection. The body may encounter surplus cortisol through multiple avenues, such as oral tablets, injections, topical creams, and inhalers.

Endogenous: Endogenous Cushing’s syndrome occurs when the body generates an excessive amount of cortisol internally. This overproduction is often linked to tumors located in the pituitary gland, adrenal gland, or from ectopic tumors found in organs such as the lungs, pancreas, or thymus. This form of Cushing’s syndrome is less common, with an incidence rate of approximately 10 to 15 cases per million individuals annually. It predominantly affects women and is most frequently observed in individuals aged between 20 and 50 years. When the excess cortisol is a result of a tumor in the pituitary gland, the condition is specifically referred to as Cushing’s disease.

Early warning signs of Cushing’s syndrome:

• Excess weight around belly (central obesity)
• Rounded or puffy face (moon face)
• Excess hair growth on face, neck, chest, abdomen, and thighs (hirsutism)
• Significant upper back fat (buffalo hump)
• Thin arms and legs
• Dark red-purple stretch marks on chest and belly

Cushing’s syndrome: Diagnosis

The diagnosis of endogenous Cushing’s syndrome presents significant challenges. It begins with the detection of elevated cortisol levels in blood, urine, or saliva, followed by the identification of the source, which may be the pituitary gland, adrenal gland, or an ectopic location. This process includes measuring ACTH levels and employing imaging techniques such as MRI or CT scans, along with advanced diagnostic methods like nuclear medicine Octreotide scanning and Inferior Petrosal Sinus Sampling (IPSS). Upon determining the source, the primary treatment typically involves surgical intervention to excise the tumor responsible for the condition. Patients diagnosed with pituitary-related Cushing’s disease may often require additional surgical procedures, gamma knife radiosurgery, or pharmacological therapies to manage elevated cortisol levels, as explained by Dr. Pranav A Ghody.

Prevention tips:

Medication management: Given that exogenous glucocorticoids are the primary cause of Cushing’s syndrome, it is recommended to administer the lowest effective dose of glucocorticoids for the briefest duration, under the guidance of a healthcare professional.

Genetic counseling: For those with a familial background of pituitary tumors or adrenal gland irregularities, genetic counseling can assist in identifying individuals who may require regular monitoring. Although there is a genetic predisposition, the formation of tumors cannot be entirely averted.

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