DEAR DR. GOTT: As a faithful reader of your column, I have a request: Would you please mention, on April 8, if possible, that April 8 is Cushing’s Awareness Day?
The world needs to know of this disease. It has changed my life. I was a healthy woman until the age of 55. I knew then that “something” was wrong. Long story short: After more a year, I was diagnosed with Cushing’s disease. I have had two brain surgeries, Graves’ disease, recurring Cushing’s and 25 radiation treatments to the pituitary. Eight years later, I still live with the effects of this monster. I am on thyroid medication for life. I have high blood pressure and other health issues, as well. I just want the world to know of this disease. Even if only one person is helped by your printing information about this topic, then a wonderful thing will have been done. Thank you, Dr. Gott.
DEAR READER: Unfortunately, I was not able to print your letter, having only received it on April 6. It takes about three weeks before any letter appears in the newspaper. I will, however, print a general overview of the condition.
Cushing’s syndrome is a rare endocrine disorder. It occurs when the body produces or receives too much cortisol over an extended period of time. It can be the result of prolonged use of high doses of glucocorticosteroids, such as prednisone, or from a malfunction of the body’s natural production. This can be the result of pituitary adenomas (up to 70 percent of cases, known as Cushing’s disease), ectopic ACTH (adrenocorticotropic hormone) syndrome (ACTH-secreting tumors or cancer outside the pituitary), and rarely can be caused by adrenal tumors or inherited.
Cortisol is a vital component in the body. It helps the body respond to stress, maintain blood pressure and cardiovascular function, regulates carbohydrate, fat and protein metabolism, reduces the inflammatory response of the immune system, and balances the effects of insulin.
The most common symptoms include a rounded face and upper body (abdomen, upper back, neck and between the shoulders (“buffalo hump”), obesity and relatively slender arms and legs. Other symptoms can include acne, slow-healing cuts, bites or infection, bone loss, muscle weakness, fatigue, cognitive difficulties, high blood pressure, high blood glucose levels, headaches, thin skin with easy bruising, purple/red stretch marks, depression and/or anxiety, abnormal menstruation and excess body and facial hair in women, and erectile dysfunction and a decrease in libido and fertility in men. Children typically present with obesity and slowed growth.
Treatment depends on the cause. Steroid use to control/treat another condition often requires lowering the dosage or, if possible, switching to a nonsteroid medication. Pituitary adenomas are most often surgically removed. If surgery fails or isn’t an option, radiation therapy and/or cortisol-inhibiting drugs may be used. Ectopic ACTH syndrome can be cured by total removal of the abnormal ACTH-secreting tissue; however, these can be microscopic or widespread at diagnosis and difficult to locate. Cortisol-inhibiting drugs are beneficial. If the abnormal source of the ACTH cannot be found, removal of the adrenal glands may be recommended. Adrenal tumors are also treated by surgical removal of the adrenal glands.
Anyone interested in learning more can go online to the National Institute of Diabetes and Digestive and Kidney Diseases (www2.niddk.nih.gov/), the Hormone Foundation (www.hormone.org) or Cushing’s Support and Research Foundation (www.csrf.net). If you think you may have the condition, talk to your physician and ask to be tested for it. If he or she is unable or unwilling, ask for a referral to an endocrinologist.