Sudden weight gain, and unusual body changes can sometimes hint at more than mere lifestyle factors. These signs, as well as high blood pressure, may point to a lesser-known condition called Cushing’s syndrome. Although it is rare, Cushing’s syndrome can still impact around 2 to 3 people per million each year. This disease is named after Dr. Harvey Cushing himself, who first identified it in the early 1930s.
Cushing’s syndrome occurs when the body produces too much cortisol, a hormone that manages stress and other bodily functions. While cortisol is good, having it in excess is where the problem comes in. Having a high cortisol level for too long leads to weight gain and other Cushing’s syndrome symptoms. Let us look at how to diagnose and treat Cushing’s syndrome.
Diagnosing Cushing’s Syndrome
Initial Screening Test
The initial screening tests for Cushing’s syndrome are basically aimed at figuring out how much cortisol levels you have in your body. The first test to be done is a 24-hour urine test. At the hospital, you’ll collect your urine over 24 hours. Then the doctor will measure cortisol levels on the sample. If you have high cortisol levels in the urine, you may have Cushing’s syndrome.
Secondly, you’ll be asked for a late night saliva test. Normally cortisol levels drop at night. For this test, you’ll have to take a saliva sample late in the evening. If you have a high cortisol level at night, it could be a sign of Cushing’s syndrome.
There’s a test called dexamethasone suppression. The dexamethasone in the term is a steroid. For this test, you’ll take a small dose at night, the next day the doctors will check your blood cortisol levels and see what it says. In normal cases, the cortisol would go down. But if it doesn’t, it might be a sign of Cushing’s syndrome.
Diagnostic Tests
Diagnostic tests include an imaging test like a CT scan or MRI of the pituitary and adrenal glands. These tests help doctors to look for growths or tumors in the pituitary or adrenal glands, which cause high cortisol levels.
Secondly, the petrosal sinus sampling is done. This test basically takes blood from veins near the pituitary gland to see if a pituitary tumor is causing ACTH (a hormone that increases cortisol).
Furthermore, blood samples are taken from veins near the adrenal glands. This step will be able to show if one of the adrenal glands is making too much cortisol directly.
Treatment of Cushing Syndrome
The idea of treatment for Cushing’s syndrome is to first tackle whatever is causing the high cortisol levels. There are a few ways the doctor does that.
Pituitary Tumor Treatment
Surgery (Transsphenoidal surgery): This surgery removes the tumor in the pituitary gland through the nose. It may sound scary but that’s the common approach used for pituitary tumors.
Medication: If surgery isn’t an option medicines can help reduce cortisol. The doctor can prescribe drugs like dopamine agonists and somatostatin analogs which will help to lower hormone levels.
Radiation therapy: If for some reason, surgery doesn’t remove all the tumor. Radiation through radiation therapy can shrink the tumor over time, which can help lower cortisol levels.
Treatment for ACTH-Producing Tumors In Other Parts Of The Body
If the tumor that’s making extra ACTH is outside he pituitary gland, doctors often remove it with surgery.
Adrenal Tumor Treatment
If there’s a tumor on one of the adrenal glands (the gland that produces cortisol), removing it or the affected adrenal glan can help bring the cortisol levels back to normal.
Conclusion
Cushing’s syndrome, though rare, can be diagnosed and treated effectively. Diagnosis starts with initial tests to check cortisol levels in urine and saliva and may include advanced imaging like CT scans or MRIs to identify possible tumors. Then the treatments are based on what’s causing you to have high cortisol levels. Whatever the case may be, there are ways to treat the underlying cause: pituitary or adrenal tumors may require surgery, medications, or radiation, while ACTH-producing tumors elsewhere are also managed surgically.
