Cushing’s disease before and after photos that is the Cushing syndrome condition in which your body produces too much of the hormone cortisol over time. This can be caused by taking oral corticosteroid medication, or your body may produce too much cortisol naturally.
Symptoms of Cushing syndrome can include a fatty hump between your shoulders, a rounded face, pink or purple stretch marks on your skin, high blood pressure, and bone loss. In some cases, Cushing syndrome can also cause type 2 diabetes.
Cushing’s Syndrome (CS) is a rare problem that occurs when the adrenal gland(s) produce too much of the hormone cortisol. CS is most often caused by a tumor or mass found in the pituitary gland, but can also be caused by tumors in the adrenal glands themselves. Cushing’s syndrome (CS) is a disorder that results from the overproduction of the hormone cortisol.
People with CS may have a “moon face,” gain weight in unusual ways, bruise easily, or feel weak, tired, and sad. Women and men may also notice fertility and other problems. CS is most often found in adults between the ages of 20 and 50.
Before Cushing’s disease
The adrenal glands are found above each kidney. They are triangle-shaped and measure approximately half an inch in height and three inches in length.
Each adrenal gland has two layers:
-The adrenal medulla (inner part) produces epinephrine (also called adrenaline).
-The adrenal cortex (outer part) produces steroid hormones such as cortisone and aldosterone. The adrenal glands help to control many processes in the body. Their job is to keep the body in balance by producing various hormones that are critical for maintaining good health.
These hormones are responsible for a variety of things like regulating fluid and salt levels which then affects blood volume and pressure. They also help the body react to stress and change. They cause a faster heart rate and help other systems in the body that might be needed for a burst of energy when needed. Problems with the cortex or medulla can then result in high blood pressure.
Cortisol levels are regulated by the pituitary gland, which is found at the base of the brain. The hypothalamus, another area of the brain, produces the corticotropin-releasing hormone (CRH). CRH tells the pituitary gland to release signals that control how much cortisol the adrenal glands make.
The pituitary gland signal is called corticotropin or adrenocorticotropic hormone (ACTH). The pituitary gland is able to detect when cortisol levels are high enough, and then it stops sending signals. This feedback system works like a thermostat to keep cortisol levels in balance. It’s a highly controlled system.
Signs of Cushing’s disease
Symptoms of CS typically appear gradually over time, and can vary in severity from person to person. Some people may only experience a few symptoms while others may show greater changes.
Common signs of CS include:
“Moon face” (a round and full face) “Buffalo hump” (a fat bulge between the shoulders) Gaining weight around your belly Skin becomes thin. You may bruise easily and find pink or purple stretch marks on your belly High blood pressure High blood sugar Fatigue and trouble sleeping (cortisol is released based on normal sleep patterns) Mood swings and sadness.
The signs of CS (Cushing’s Syndrome) often develop slowly over time and may not be noticeable at first. A series of pictures comparing a person’s appearance over time is often the best way to show the changes that have occurred. Doctors sometimes describe patients with CS as having “Cushingoid” features, which are also side effects of cortisone-related drugs such as prednisone and prednisolone.
Common cause of Cushing’s Syndrome
- The most common cause of Cushing’s Syndrome is a benign pituitary tumor (adenoma), which makes up for approximately 75-85% of all CS cases. Corticotropin (CRH) is a hormone that’s normally produced by the pituitary gland and it acts as a trigger for the adrenal gland to release cortisol – especially during times of stress. When there’s a pituitary tumor present, it results in an overproduction of corticotropin (also referred to as ACTH). ACTH is essentially a switch that controls the growth and activity of the adrenal glands; too much ACTH means that the adrenal gland produces too much cortisol.
- An adrenal tumor is an important cause of CS. The tumor may or may not be cancerous.
- Ectopic (Abnormal) ACTH This is when CS is caused by tumors that make ACTH in other organs, for example, tumors found in the chest on the lung or thymus.
- Steroids can cause Cushing’s syndrome (CS) when used in high doses for long periods of time. For example, the use of prednisone can lead to CS. It is normal to find high levels of cortisol in the body from stress. This does not lead to Cushing’s syndrome. In very rare cases, there is a hereditary link to an endocrine tumor that could cause CS. However, most cases of CS are not passed down genetically.
- CS can be difficult to diagnose because the signs may not be apparent and can be mistaken for other health problems. It’s important to see a health care provider to rule out CS as a possibility. A diagnosis is based on: Your health history A physical exam Lab tests for cortisol levels.
- The Dexamethasone Suppression Test is conducted by administering a dexamethasone (steroid) pill orally, and then measuring the cortisol levels in the body via a blood test. Normally, the extra steroid would suppress the body’s cortisol production. However, in a person with Cushing’s Syndrome, the levels of cortisol will remain high.
- The 24-hour urinary free cortisol test is a urine test that measures the levels of cortisol in your body over a full 24-hour period. This test is sometimes used to diagnose adrenal problems, but more tests would be needed to confirm a diagnosis.
- If CS is diagnosed, your doctor may order additional tests to find the underlying cause, such as blood tests and imaging tests. Blood tests can reveal low levels of corticotropin, which may indicate an adrenal tumor. Your doctor will likely confirm the diagnosis with a CT scan or MRI. If slightly higher levels of corticotropin are present, it may suggest a pituitary tumor. In this case, an MRI of the brain can often confirm the diagnosis. If the pituitary tumor is very small, your doctor may need to order more tests. If ACTH levels are very high, it suggests an ectopic ACTH tumor.
- Imaging tests such as CT scans or MRIs are excellent at finding pituitary or adrenal tumors. They provide clear and concise views of the body and are painless, accurate, and quick.
Treatment for excess cortisol
- The treatment for excess cortisol will depend on the underlying cause. If it’s due to steroid use, your doctor may tell you to stop taking the medication or reduce your dosage. If the cause is a benign or cancerous adrenal tumor, you’ll need surgery to remove it.
- If the Cause of Steroid Use is Disease-Related In many cases, discontinuing steroid usage will enable the body to return to its natural state. However, how one goes about cutting or stopping their steroid use is contingent upon the disease being treated and the individual’s reaction to the drugs.
- If your doctor has diagnosed you with a pituitary tumor, surgery is usually the best course of treatment. The surgery is usually performed through the nose (transsphenoidal surgery) by a neurosurgeon.
- If you have an adrenal tumor, your urologist may recommend surgery to remove it. If the tumor is small (less than 4-6 cm), it’s more likely to be benign (noncancerous). It can be removed with a small incision using laparoscopic or robotic surgery. Sometimes only part of the adrenal gland is removed (a partial adrenalectomy) to leave the healthy portion behind. When laparoscopic surgery is not possible, an “open” operation is used. Open surgery is used for larger or more difficult tumors. If the mass is larger than 4-6 cm, it’s more likely to be cancerous.
After Cushing’s disease
- After treatment, most patients feel better and the problem is often cured. In very rare cases of adrenal cancer, less than 50 out of 100 people will be cured. However, treatment for an adrenal adenoma (non-cancerous tumor) is usually successful.
- The quality of life for a person with CS greatly depends on the factors listed below:
-The amount of extra cortisol in their system
-How long they have had the disease
-How healthy they are in general -How easy it is to cure the type of CS they have
- If CS is cured, all of the symptoms of the disease will go away. This may take as long as 2 to 18 months after treatment. The slow improvement can be hard to take, but you will feel better. As you improve, you will need frequent calls and visits to your health care provider.
- If the CS is not curable, or if you still have CS from steroids, you may have to cope with the signs mentioned earlier. (Things like: fatigue, muscle weakness, abdominal and facial weight gain, depression, mood swings.) Drugs can help with these ongoing symptoms.
- Most people feel better quickly after laparoscopic surgery to remove an adrenal tumor. You can often leave the hospital within 1 or 2 days with no restrictions. Often patients feel back-to-normal in about 3 to 5 weeks. Recovery from open surgery will take longer. You may stay in the hospital for 5 to 10 days, and full healing takes up to 8 weeks.
- Adrenal surgery is a complex procedure, and it’s important to choose a surgeon who has significant experience in this area. Talk to a few different surgeons before making your decision. After surgery, you may need steroids to avoid a deficiency while the gland recovers. This process may take up to a year. Rarely, the adrenal gland that shut down will not recover. In this case, steroids may be needed as replacement therapy.