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  Cushings syndrome

Cushings’s syndrome is a rare disorder of the endocrine system that is marked by excessive amounts of the endogenous (bodily produced) corticosteroid hormone cortisol. This disease can begin iatrogenically (a substance or cause from outside the body) with treatments of corticosteroids for other medical syndromes. This disease was discovered and so named by American endocrinologist and surgeon Harvey Cushing in 1932.

Cushings syndrome Neurological disorder
Cushings syndrome


Symptoms

Symptoms for Cushing’s syndrome are excessive sweating, dilation of capillaries (telangiectasia), atrophy of the skin(resulting in easy bruising), rapid weight gain in the trunk and face (central obesity), moon face, atrophy of mucus membranes, red or purple striae on the trunk, breasts, buttocks, arms or legs, muscle weakness in the hips and shoulders and facial hair growth(hirsutism). Another common symptom is fat pads developing along the collar bone and the back of the neck (buffalo hump). The excessive cortisol can also impact other endocrine functioning leading to reduced sex-drive, impotence, amenorrhea and infertility. Some patients experience euphoria, psychosis, depression, anxiety and panic attacks.

Hypertension, insulin resistance and hyperglycemia leading to diabetes mellitus can develop from Cushing’s syndrome. Untreated, Cushing’s syndrome can cause heart diseased and increased risk of mortality. Cushing’s syndrome that is caused by excess ACTH can lead to hyper-pigmentation of the skin.

Diagnosis

Cushing’s syndrome is diagnosed with a dexamethasone suppression test. This test involves the administration of dexamethasone and then frequent checks of the blood levels of cortisol and ACTH levels. A 24 hour urinary measurement of cortisol levels can also be used to diagnose Cushing’s syndrome. It is necessary to rule out pituitary lesions by checking for visual field impairments, levels of other pituitary hormones in the blood stream and a physical exam.

After a positive test result, a CT scan of the adrenal gland and an MRI of the pituitary gland should be performed. This is used to rule out incidentalomas (which are harmless lesions on both organs, that may cause increased hormone levels).

Treatment

Treatment depends on the cause of the disease. If an adrenal adenoma is detected, then it would be removed surgically. If a pituitary ACTH secreting adenoma is present, it would also be removed, if possible by surgery. Steroid replacement therapy is required after surgery. This will suppress pituitary ACTH secretions and replace secretions of normal adrenal tissue, if recovery does not occur. If both adrenal glands require extraction, then hydrocortisone or prednisolone replacement must occur indefinitely.

Patients who cannot undergo surgery can choose from a number of drugs that inhibit cortisol production, but the success is limited.

Sometimes the adrenal glands are removed even when no lesions are detected, in order to suppress the excess cortisol.

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