Cushing's syndrome: understanding this rare condition

In February 2024, Amy Schumer addressed online comments about her "puffier" appearance, by revealing she has Cushing's syndrome. The comedian said the original internet speculation about her appearance led to her investigating what was going on with her health: "That's how I realized something was wrong. The internet is undefeated, as they say."

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Adrenal health -

Cushing's is relatively rare, so you might not have heard of it. In order for Cushing's syndrome to occur, there must be excess cortisol in the body. Cortisol is made by the adrenal glands, which sit on top of the kidneys.

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Cortisol -

Cortisol plays an important role in the body, helping it use food for energy, controlling blood sugar and pressure, reducing inflammation, and helping the heart work properly so we can perform at our best.

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Steroids -

Both Cushing's syndrome and Cushing's disease come from having too much cortisol. In Cushing's syndrome, the excess cortisol can come from inside or outside of the body.

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Steroids -

Examples of things outside the body that can lead to the development of Cushing's syndrome are corticosteroid medications, including prednisone.

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Glucocorticoid medicines (exogenous Cushing syndrome) -

Often used to treat inflammatory diseases such as rheumatoid arthritis, lupus, and asthma, glucocorticoids can cause exogenous Cushing's syndrome. Taken in any form, for a long time, these medications can lead to a diagnosis.

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Adrenal tumor -

Internally, the excess of cortisol can come from the pituitary gland or an adrenal tumor that causes the glands to produce too much cortisol.

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Cushing's disease -

Cushing's disease is a particular type of Cushing's syndrome. It occurs when the pituitary has a tumor, that causes the body to produce too much cortisol.

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ACTH -

When a non-cancerous (benign) tumor sits on the pituitary, the gland makes too much of a hormone called ACTH. In response, the adrenal glands above each kidney produce too much cortisol, throwing off the hormone balance in the body. Only 10% of pituitary adenomas make too much ACTH, to cause Cushing's disease.

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Pituitary gland -

Cushing's disease is the most common Cushing syndrome that occurs from within the body, accounting for 70% of all Cushing syndrome cases.

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Familial Cushing's syndrome -

Rarely, people inherit a tendency to get tumors on one or more of their endocrine glands. These glands in the body make hormones. If these tumors make ACTH or cortisol, Cushing's can also happen.

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Incidence -

Cushing's affects around three times as many women as men. Typically, people aged between 20 and 50 are most susceptible. It's common for the condition to go undiagnosed, and it's possible the real figures are much higher than we know.

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Symptoms: Tummy weight gain -

Symptoms of Cushing's disease can begin slowly or rapidly. One of the main signs is weight gain and more body fat, particularly around the tummy area/middle.

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Hump on the back of the neck -

There can be a buildup of fat on the upper back, neck, and shoulders that resembles a hump, and is actually known as "buffalo hump."

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Redness and moon face -

A puffy, red, rounded face, which is commonly referred to as "moon facies" or "moon face," is also a symptom of Cushing's syndrome.

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Feeling low -

Cortisol provides the energy we need to motivate us to get through the day. However, when hormones are out of balance, depression and mood swings can follow, and these symptoms are indicative of Cushing's syndrome.

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Other complications -

Cushing's can also cause symptoms including low libido, headaches, memory loss, extreme fatigue (or trouble sleeping), vision problems, loss of periods, high blood sugar, or high blood pressure.

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Other complications -

Without treatment, Cushing's can cause bone loss (osteoporosis), which can lead to broken bones, as well as a loss of muscle mass and strength.

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Testing for Cushing's: ruling out other disorders -

As the symptoms of Cushing's can be quite general or overlap with the symptoms of several other conditions, it's necessary to test specifically for elevated ACTH and cortisol.

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Urine test -

One of the ways your healthcare provider can test for Cushing's is with a urine sample. Someone with the syndrome will have elevated cortisol in their urine sample.

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Blood test -

A blood sample can be taken (usually in the morning, as hormones fluctuate throughout the day), to test for levels of ACTH and cortisol in the blood.

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MRI -

If a pituitary tumor needs to be ruled out, your doctor might send you for an MRI scan, which provides a picture of your brain.

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Abdominal CT scan -

An abdominal CT scan might be recommended if it's possible that symptoms are caused by a tumor on the adrenal gland, impacting the levels of cortisol in the body.

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Diagnosis -

To confirm the diagnosis, the doctor may prescribe medications to raise or lower the levels of certain hormones. This will help confirm the source is Cushing's and not another condition such as stress, depression, or alcoholism.

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Diagnosis -

If high ACTH is the cause of symptoms, and the pituitary gland has been confirmed as the source of it, the doctor will put the patient in touch with a neurosurgeon.

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Treatment: Surgery -

Surgery to remove a problematic tumor is one of the first treatments for Cushing's disease, if discovered. During the procedure, the tumor is removed via the nose.

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Medication -

For some patients, medication is the appropriate treatment. Whether for Cushing's syndrome or disease, the drugs will reduce the amount of cortisol in the body. However, as a side effect, this can lead to insufficient cortisol, which causes fatigue and muscle weakness.

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Radiation therapy -

If the disease is aggressive and surgery and medication don't work, radiation therapy might be suggested as a potential treatment. Targeted stereotactic radiosurgery is employed to control hormone levels.

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Awareness -

Being aware of the syndrome is the first step. Contact your doctor and arrange to have some tests run if you suspect you could be at risk for Cushing's syndrome or disease.

Sources: (OHSU Brain Institute) (Mayo Clinic) (NHS) (Healthline)

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Getty Images

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Amy Schumer's diagnosis -

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Adrenal health -

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Cortisol -

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Steroids -

Both Cushing's syndrome and Cushing's disease come from having too much cortisol. In Cushing's syndrome, the excess cortisol can come from inside or outside of the body.

Shutterstock

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Steroids -

Examples of things outside the body that can lead to the development of Cushing's syndrome are corticosteroid medications, including prednisone.

Shutterstock

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Glucocorticoid medicines (exogenous Cushing syndrome) -

Shutterstock

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Adrenal tumor -

Internally, the excess of cortisol can come from the pituitary gland or an adrenal tumor that causes the glands to produce too much cortisol.

Shutterstock

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Cushing's disease -

Cushing's disease is a particular type of Cushing's syndrome. It occurs when the pituitary has a tumor, that causes the body to produce too much cortisol.

Shutterstock

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ACTH -

Shutterstock

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Pituitary gland -

Cushing's disease is the most common Cushing syndrome that occurs from within the body, accounting for 70% of all Cushing syndrome cases.

Shutterstock

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Familial Cushing's syndrome -

Rarely, people inherit a tendency to get tumors on one or more of their endocrine glands. These glands in the body make hormones. If these tumors make ACTH or cortisol, Cushing's can also happen.

Shutterstock

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Incidence -

Shutterstock

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Symptoms: Tummy weight gain -

Symptoms of Cushing's disease can begin slowly or rapidly. One of the main signs is weight gain and more body fat, particularly around the tummy area/middle.

Shutterstock

13 / 30 Fotos

Hump on the back of the neck -

There can be a buildup of fat on the upper back, neck, and shoulders that resembles a hump, and is actually known as "buffalo hump."

Shutterstock

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Redness and moon face -

A puffy, red, rounded face, which is commonly referred to as "moon facies" or "moon face," is also a symptom of Cushing's syndrome.

Shutterstock

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Feeling low -

Shutterstock

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Other complications -

Cushing's can also cause symptoms including low libido, headaches, memory loss, extreme fatigue (or trouble sleeping), vision problems, loss of periods, high blood sugar, or high blood pressure.

Shutterstock

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Other complications -

Without treatment, Cushing's can cause bone loss (osteoporosis), which can lead to broken bones, as well as a loss of muscle mass and strength.

Shutterstock

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Testing for Cushing's: ruling out other disorders -

As the symptoms of Cushing's can be quite general or overlap with the symptoms of several other conditions, it's necessary to test specifically for elevated ACTH and cortisol.

Shutterstock

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Urine test -

One of the ways your healthcare provider can test for Cushing's is with a urine sample. Someone with the syndrome will have elevated cortisol in their urine sample.

Shutterstock

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Blood test -

A blood sample can be taken (usually in the morning, as hormones fluctuate throughout the day), to test for levels of ACTH and cortisol in the blood.

Shutterstock

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MRI -

If a pituitary tumor needs to be ruled out, your doctor might send you for an MRI scan, which provides a picture of your brain.

Shutterstock

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Abdominal CT scan -

An abdominal CT scan might be recommended if it's possible that symptoms are caused by a tumor on the adrenal gland, impacting the levels of cortisol in the body.

Shutterstock

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Diagnosis -

Shutterstock

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Diagnosis -

If high ACTH is the cause of symptoms, and the pituitary gland has been confirmed as the source of it, the doctor will put the patient in touch with a neurosurgeon.

Shutterstock

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Treatment: Surgery -

Surgery to remove a problematic tumor is one of the first treatments for Cushing's disease, if discovered. During the procedure, the tumor is removed via the nose.

Shutterstock

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Medication -

Shutterstock

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Radiation therapy -

Shutterstock

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Awareness -

Being aware of the syndrome is the first step. Contact your doctor and arrange to have some tests run if you suspect you could be at risk for Cushing's syndrome or disease.

Sources: (OHSU Brain Institute) (Mayo Clinic) (NHS) (Healthline)

Shutterstock

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Cushing's syndrome: understanding this rare condition

High levels of cortisol disrupt the body's balance

30/10/24 | StarsInsider

HEALTH Chronic illness

Cushing's syndrome is a relatively rare medical disorder, and yet around 10 to 15 million new cases are diagnosed in the US each year. Still, it can go undiagnosed for years if symptoms are mild enough. But this doesn't make it any less distressing for sufferers. Without treatment, the condition gradually gets worse.

And did you know that it affects three times as many women as men? Or that there are some differences between the syndrome and Cushing's disease? And do you even know the signs to look out for? For these answers and more, click on to learn about this troubling condition.