What is Cushing’s disease?

Cushing's disease is a medical condition caused by prolonged exposure to high levels of a hormone called cortisol in the body. Cortisol is a hormone produced by the adrenal glands and plays a crucial role in regulating various bodily functions, including metabolism, immune response, and the body's response to stress.

In Cushing's disease, an overproduction of cortisol can occur due to a noncancerous tumor in the pituitary gland. This tumor prompts the pituitary gland to release excessive amounts of adrenocorticotropic hormone (ACTH), which, in turn, signals the adrenal glands to produce more cortisol than the body needs.

Symptoms of Cushing’s disease

• Weight gain

• Muscle weakness

• Skin changes

• Fatigue

• High blood pressure

• Mood changes

• Irregular menstruation

• Increased thirst and urination

• Osteoporosis

• Cognitive changes

• Facial hair and acne

• Slow wound healing

• Round face

What causes Cushing’s disease?

Cushing's disease is primarily caused by an overproduction of the hormone cortisol in the body. This overproduction typically results from a noncancerous tumor located in the pituitary gland, which is a small gland at the base of the brain. The tumor is usually a benign adenoma, meaning it is not cancerous.

Here's how this process works:

• Pituitary tumor: The most common cause of Cushing's disease is a pituitary tumor, specifically an adenoma. These tumors are often small and noncancerous but can produce excessive amounts of adrenocorticotropic hormone (ACTH).

• ACTH production: The pituitary tumor prompts the overproduction of ACTH. ACTH is responsible for stimulating the adrenal glands, which are situated on top of the kidneys, to produce cortisol.

• Excess cortisol: The elevated levels of ACTH in the bloodstream result in the adrenal glands producing more cortisol than the body needs. This excess cortisol leads to the various symptoms and health problems associated with Cushing's disease.

In some cases, Cushing's syndrome, which includes the same symptoms but is not caused by a pituitary tumor, can be triggered by other factors:

• Adrenal tumors: Occasionally, noncancerous or cancerous tumors can develop in the adrenal glands themselves, causing them to overproduce cortisol.

• Ectopic ACTH production: In rare cases, tumors outside the pituitary or adrenal glands (ectopic tumors) can produce ACTH, leading to excess cortisol production.

• Long-term steroid use: Prolonged use of corticosteroid medications, such as prednisone, for other medical conditions can also result in Cushing's syndrome.

How do you diagnose Cushing’s disease?

• A healthcare provider will begin by conducting a thorough medical history and physical examination. They will look for common signs and symptoms of Cushing's disease, such as weight gain, muscle weakness, and changes in skin appearance.

• Blood and urine tests are used to measure cortisol levels. Elevated cortisol levels may indicate Cushing's disease. These tests can be performed at different times of the day to assess the body's natural cortisol rhythm.

• In some cases, a blood test is performed to measure the levels of adrenocorticotropic hormone (ACTH). Elevated ACTH levels can suggest that the source of excess cortisol production is in the pituitary gland (Cushing's disease) rather than the adrenal glands.

• A dexamethasone suppression test involves taking a synthetic glucocorticoid medication called dexamethasone, which should normally suppress cortisol production. If cortisol levels remain high after dexamethasone administration, it may indicate Cushing's disease.

• Imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, may be performed to visualize the pituitary gland and adrenal glands. These scans can help identify the presence of tumors or abnormalities.

• In cases where the source of excess ACTH production is not clear, an Inferior Petrosal Sinus Sampling (IPSS) test may be performed. This procedure involves sampling blood from the veins that drain the pituitary gland to measure ACTH levels and pinpoint the source of the problem.

• A high-dose dexamethasone suppression test involves administering a high dose of dexamethasone to determine if it can suppress ACTH and cortisol production. It helps differentiate between pituitary and ectopic sources of ACTH.

• Sometimes, multiple salivary cortisol tests may be conducted over 24 hours to assess the diurnal variation in cortisol levels.

• Due to the potential for bone loss and osteoporosis in Cushing's disease, a bone density scan (DEXA scan) may be performed to assess bone health.

Treatment options for Cushing’s disease

Treatment for Cushing's disease aims to reduce the overproduction of cortisol and alleviate the associated symptoms and health risks. The approach to treatment may vary depending on the underlying cause of the condition, which is typically due to a pituitary tumor (adenoma). Here are the main treatment options for Cushing's disease:

• Surgical removal of the pituitary tumor (Transsphenoidal surgery): This is the most common and often the preferred treatment option for Cushing's disease caused by a pituitary adenoma. During this procedure, a neurosurgeon removes the tumor through the nasal passage, avoiding the need for a more invasive surgery. Successful removal of the tumor can lead to a significant reduction in cortisol production.

• Radiation therapy: In cases where surgical removal of the tumor is not possible or the tumor persists, radiation therapy may be considered. This therapy aims to shrink or control the tumor, reducing excess hormone production. There are various forms of radiation therapy, including conventional external-beam radiation and stereotactic radiosurgery.

• Medical therapy: Medical treatment options may be used when surgery is not successful, when the patient is not a candidate for surgery, or as a preoperative treatment to improve the chances of a successful surgical outcome. Common medications include:

  • Corticosteroid receptor blockers: These drugs, such as ketoconazole, mifepristone, and metyrapone, block the effects of excess cortisol in the body, helping to control symptoms.

  • Pituitary-directed medications: Certain medications, like pasireotide, work by targeting the source of excess ACTH production in the pituitary gland.

• Bilateral adrenalectomy: In very rare cases where other treatments have failed, or if the underlying cause is bilateral adrenal tumors, both adrenal glands may be surgically removed. This procedure eliminates cortisol production but requires lifelong hormone replacement therapy.

• Lifestyle management: Patients may be advised to make lifestyle changes to improve their overall health, including managing weight, controlling blood pressure, and addressing other complications like diabetes. Bone health and mental well-being should also be monitored.

After successful treatment, patients often experience a gradual improvement in symptoms and overall health. However, long-term follow-up and monitoring in partnership with your endocrinologist are essential to manage any potential recurrence or complications associated with Cushing's disease.

Natural ways to manage Cushing’s disease

Managing Cushing's disease through natural approaches can complement medical treatments and help alleviate some of the symptoms associated with the condition. While natural remedies may not replace medical interventions, they can offer support in improving overall health and well-being. Here are some natural approaches to consider:

• Diet and nutrition: A balanced and healthy diet is essential. Focus on:

  • Low-sodium diet: Reducing salt intake can help manage high blood pressure, a common symptom of Cushing's disease.

  • Anti-inflammatory foods: Incorporate foods rich in antioxidants and anti-inflammatory properties, such as fruits, vegetables, whole grains, and fatty fish.

• Exercise: Regular physical activity can assist in weight management and muscle strength. Consult with a healthcare provider to create a safe and suitable exercise plan.

• Stress reduction: Chronic stress can exacerbate Cushing's symptoms. Stress-reduction techniques like meditation, yoga, and deep breathing exercises can be beneficial.

• Sleep: Prioritize getting enough restful sleep, as sleep disturbances can worsen Cushing's disease symptoms. Maintain a consistent sleep schedule and create a comfortable sleeping environment.
• Herbal supplements: Some herbal supplements may have cortisol-lowering properties. These include ashwagandha, licorice root, and curcumin. However, consult a healthcare provider before adding these supplements to your regimen.