CUSHING SYNDROME

(Hypercortisolism and
Cortisol excess)

Cushings syndrome occurs due to abnormally high levels of the hormone

cortisol. This can happen for a variety of reasons. The most common cause is
overuse of corticosteroid medications.

Cushing's syndrome is a hormonal

disorder caused by prolonged exposure of the body's tissues to high levels of

the hormone cortisol.
Cushing's syndrome is relatively rare and most commonly affects adults aged 20 to
50. People who are obese and have type 2 diabetes, along with poorly controlled
blood glucose-also called blood sugar-and high blood pressure, have an increased
risk of developing the disease.

Symptoms:

1. Weight gain
2. Obesity

3. Excess hair growth on the face, neck, chest, abdomen,

and thighs

4. Thinning skin that bruises easily,skin injuries that are

slow to heal
5. fatigue
6. muscle weakness
7. glucose intolerance
8. increased urination,thrist
9. bone loss
10. high blood pressure
11. cognitive dysfunction
12. anxiety,dipression
13. irritability
14. erectile dysfunction
15. other inflammatory diseases

CAUSES:
The most common cause of Cushings syndrome is the use of
corticosteroid medications, such as prednisone, in high doses
for a depression, panic disorders, or high levels of emotional
People taking high doses of corticosteroids,glucocorticoids
Reason for excess of GLUCOCORTICOIDS administration:

 Because they take glucocorticoids-steroid hormones that are

chemically similar to naturally produced cortisolsuch as
prednisone for asthma, rheumatoid arthritis, lupus, and.
Excess levels of the hormone cortisol are responsible for Cushing syndrome.
Cortisol, which is produced in the adrenal glands, plays a variety of roles in
your body.
For example, cortisol helps regulate your blood pressure and keeps
your cardiovascular system functioning normally.

Responding to stress
Regulating blood pressure and the cardiovascular system
Reducing the immune systems inflammatory response
Converting carbohydrates, fats, and proteins into energy
Balancing the effects of insulin

Women with Cushing syndrome may experience:

Thicker or more visible body and facial hair (hirsutism)

Irregular or absent menstrual periods

Men with Cushing syndrome may experience:

Decreased libido

Decreased fertility

Erectile dysfunction

OTHER CAUSES :
Tumor of the pituitary gland
Tumor of the adrenal gland

 ACTH-producing tumors (ectopic) elsewhere in the body

Multiple endocrine neoplasia 1 (MEN1)
Glucocorticoid hormone therapy.

LABORATORY TEST TO FIND THE CAUSE OF

CUSHING SYNDROME:
1.
2.
3.
4.

CRH stimulation test.

High-dose dexamethasone suppression test (HDDST).
Radiologic imaging.
Petrosal sinus sampling

DIAGNOSIS OF CUSHING SYNDROME:

Cushing syndrome can be difficult to diagnose, particularly endogenous Cushing

syndrome, because other conditions share the same signs and symptoms.
Diagnosing Cushing syndrome can be a long and extensive process. You may not
have any firm answers about your condition until you've had a series of medical
appointments.
IT CAN ALSO BE DIAGNOSED BY FOLLOWING TESTS:

Urine and blood tests

Saliva test.
Imaging tests
Petrosal sinus samplin

TREATMENT:

Reducing corticosteroid use

Surgery
Radiation therapy
Medications

MEDICATION:
1.ketoconazole (Nizoral),
2.mitotane (Lysodren) and
3. metyrapone (Metopirone)
The newest medication for Cushing's is pasireotide (Signifor), and it works
by decreasing ACTH production from a pituitary tumor. This medication is given as an
injection twice daily. It's recommended if pituitary surgery is unsuccessful or cannot be
done.
Side effects are fairly common, and may include diarrhea, nausea, high blood sugar,
headache, abdominal pain and fatigue.
PREVENTION:
If you take a corticosteroid, know the signs and symptoms of
Cushing syndrome. Getting treated early can help prevent any long-term effects of
Cushing syndrome. If you use inhaled steroids, you can decrease your exposure to the
steroids by using a spacer and by rinsing your mouth after breathing in the steroids.

CUSHING SYNDROME IN DOGS

Hyperadrenocorticism in Dogs

Can grass kill your DOG?

The endocrine system is the collective system of organs that control hormones in the body,
one of which is the cortisone hormone, responsible for protein and
carbohydrate metabolism in the body. When a disorder of the body causes an excess of
cortisone levels in the bloodstream, the metabolic process is hampered, leading
to gastrointestinal disorders and hypertension, amongst other bodily disturbances. This
condition is medically referred to as hyperadrenocorticism, and it is one of the most common
endocrine disorders to affect dogs.

Hyperadrenocorticism can occur spontaneously due to a pituitary tumor, or, in 85 percent of

cases, to enlargement of the pituitary gland.

SYMPTOMS AND TYPES

Increased thirst and urination (polydipsia and polyuria, respectively)

Increased hunger

Increased panting

Pot-bellied abdomen

Obesity

Fat pads on the neck and shoulders

Loss of hair

Lack of energy

Inability to sleep (insomnia)

Muscle weakness

Lack of heat cycle in female dogs (anestrus)

Shrinking of testicles

Darkening of the skin

Appearance of blackheads on the skin

Thin skin (from weight gain)

Bruising (from thin, weakened skin)

Hard white scaly patches on the skin, elbows, etc. (associated with the disease
calcinosis cutis)

CAUSES:
The most common cause of HYPERADRENOCORTICISM is tumor in pituitary
gland.

Excessive glucocorticoid administration, which may be used for allergies, inflammation, or

as a replacement therapy for low cortisone levels, can also cause hyperadrenocorticism in
dogs.

TREATMENT:

Oral medication
Radiation
Surgery
Transsphenoidal surgery
ORAL MEDICATION:

Lifelong oral medication is often prescribed for

pituitary dependent Cushings disease to help manage the symptoms. The most
common drugs used to treat Cushings disease are Trilostane and o,p-DDD.

RADIATION:

Radiation may be used to shrink the size of a pituitary tumor.

This treatment is most effective on small tumors to help reduce the symptoms
of pituitary dependent Cushings disease.

SURGERY:

Treatment of adrenal dependent Cushings disease is by

surgical removal of the affected adrenal gland. Adrenal gland tumors, if

cancerous, can spread to other parts of the body in which case all the cancer
cannot be removed by surgery.

TRANSSPENOIDAL SURGERY:
It is used to remove a pituitary tumor. The
surgeon uses an exoscope, a long tube with a light at the end for magnification
and illumination, to reach the pituitary through the soft palate in the mouth to
access the base of the skull where the pituitary is located. Surgical removal of
the tumor generally eliminates the need for lifelong medication.