This is part of our House MD Project series.
Click here to read the connection to the episode (spoiler alert!)
Danger level: Medium
What is it?
Cushing’s syndrome is a condition in which there is too much of the hormone cortisol in the body.
Who gets it?
Cushing’s syndrome isn’t very common, and happens to about 13 out of every million people each year.
What causes it?
Cortisol is a steroid hormone produced in our body. It’s released in response to stress or when its level in the blood is low. Its function in our body is to raise blood sugar, suppress the immune system and help with the body’s metabolism.
To understand why Cushing’s syndrome happens, you first have to understand how our body releases and handles cortisol.
The brain makes a hormone called CRH, which tells a gland under the brain, called the pituitary gland, to make another hormone called ACTH. ACTH causes our adrenal glands (which sit above our kidneys) to produce cortisol.
Now what causes cushing’s syndrome?
- Taking steroid medicine – These aren’t the steroids you may know that athletes take. Steroids are types of drugs used to suppress our immune system and that are given in diseases such as lupus, asthma, and rheumatoid arthritis. Taking these for a long time is the most common cause of Cushing’s syndrome.
- Tumors on the pituitary gland – Like the case on the House episode. This is the second most common cause, and has a slightly different name: Cushing disease. This isn’t cancer and doesn’t spread like cancer does. What this tumor does is produce extra amounts of ACTH which cause the adrenal gland to produce more cortisol than it should.
- Tumors on the adrenal gland – These can sometimes be cancer. These tumors produce extra amounts of cortisol themselves.
- Tumors elsewhere – These can be lung tumors and others, that simply produce ACTH, causing the adrenal gland to produce extra cortisol.
How does it feel?
- The most common symptom is weight gain, especially around the waist, and around the upper back (something called a buffalo hump). It also caused a rounding of the face called moon face.
- Fatigue
- Muscle weakness
- Flushing of the face
- Skin changes: The skin bruises easily. You get acne. You get pink or purple stretch marks (called striae) on the belly skin, thighs, breasts, and arms.
- Slow healing of wounds and infections
- Mood changes, such as depression, anxiety and irritability.
- Thicker or more visible body and facial hair.
- Irregular or absent periods in women.
- Diabetes
- High blood pressure
- Bone loss, which can lead to fractures
And more…
This video from The National Geographic shows an excellent example and explains it:
How is it discovered?
There are blood tests that can find out if you have Cushing’s syndrome. Once these are done, a CT scan of your adrenal and an MRI of the pituitary gland are done to find a possible tumor.
Other tests may be possible, which are beyond the scope of this article.
How is it treated?
If the condition is caused by steroid medicine, your doctor will lower your dose or stop them altogether. You should never stop taking steroids on your own, as that can be dangerous to your health.
If a tumor is causing it, it can be removed in surgery, or by other means.
What happens after treatment?
If the surgery removes the tumor completely, people may be cured, although it can sometimes return.
The bottom line – How do I avoid it?
If you take steroids, awareness of the signs of the condition can help you avoid its continuation down the road.
What next?
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- Hashimoto’s Thyroiditis – Do You Suffer From Weight Gain, Fatigue or Hair Loss? This Might Just Be The Cause
- Neuroblastoma – The Most Common Cancer in Infants
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