Edit concept Question Editor Create issue ticket

Adrenal Cushing Syndrome


Presentation

  • We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT.[ncbi.nlm.nih.gov]
  • Clinical description The disease presents a bimodal age distribution with a rare subset presenting in the first years of life, particularly associated to McCune-Albright syndrome (MAS; see this term).[orpha.net]
  • In our case a mild form of facies lunaris was present and induced us to perform adequate hormonal tests and confirmatory imaging.[omicsonline.org]
  • These patients usually present at an older age with long standing symptoms.[healio.com]
Weakness
  • Symptoms also include fatigue, weakness, depression, mood swings, increased thirst and urination, and lack of menstrual periods in women.[nadf.us]
  • An overproduction of the aldosterone hormone can lead to high blood pressure and to those symptoms associated with low levels of potassium, such as weakness, muscle aches, spasms, and sometimes paralysis.[hopkinsmedicine.org]
  • An overproduction of the aldosterone hormone can lead to high blood pressure and to symptoms associated with low levels of potassium (for example, weakness, muscle aches, spasms, and, sometimes, paralysis).[stanfordchildrens.org]
Weight Gain
  • Polycystic ovary syndrome can cause excessive hair growth, menstrual abnormalities, weight gain, and even diabetes.[adrenalfatiguesolution.com]
  • Hypercortiolism means a high level of the adrenal hormone cortisol, which causes many symptoms including weight gain, high blood pressure, diabetes, osteoporosis, concentration deficit and increased cardiovascular deaths.[sciencedaily.com]
  • Most people with Cushing syndrome have: Round, red, full face ( moon face ) Slow growth rate in children Weight gain with fat accumulation on the trunk, but fat loss from the arms, legs, and buttocks (central obesity) Skin changes that are often seen:[medlineplus.gov]
  • Symptoms: Moon face (round, red, and full) Weight gain Buffalo hump (a collection of fat between the shoulders) Central obesity with protruding abdomen and thin extremities Skin changes Thinning of the skin Easy bruising Acne or superficial skin infections[uclahealth.org]
  • Weight gain, especially in the upper body Rounded face and extra fat on the upper back and above the collarbones High blood sugar (diabetes) High blood pressure (hypertension) Thin bones (osteoporosis) Muscle loss and weakness Thin, fragile skin that[hormone.org]
Fatigue
  • Symptoms also include fatigue, weakness, depression, mood swings, increased thirst and urination, and lack of menstrual periods in women.[nadf.us]
  • Page 47 - Insomnia or hypersomnia nearly every day 5 Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6 Fatigue or loss of energy nearly every day 7 Feelings[books.google.com]
  • Symptoms may include: upper body obesity round face increased fat around neck thinning arms and legs fragile and thin skin stretch marks on abdomen, thighs, buttocks, arms, and breasts bone and muscle weakness severe fatigue high blood pressure high blood[adrenaltumors.org]
  • […] other types of Cushing syndrome) Periods that become irregular or stop Men may have: Decreased or no desire for sex (low libido) Erection problems Other symptoms that may occur include: Mental changes, such as depression, anxiety, or changes in behavior Fatigue[medlineplus.gov]
Swelling
  • Her face appeared Cushingoid with periorbital swelling and rubor. Her thyroid was palpable without nodularity. Her abdominal exam revealed visible superficial veins but no striae.[healio.com]
  • Signs High blood pressure Diabetes Moon facies (round facial shape) Buffalo hump (mound of fat at the back of the neck) Stretch marks Abnormal hair growth Osteoporosis Symptoms Easy bruising Fatigue Weight gain (particularly around the mid-section) Leg swelling[saintjohnscancer.org]
  • […] on the back of the neck Increased and lower-extremity swelling The presence of abdominal obesity, particularly the appearance of abdominal striae (think of striae as stretch marks, like in pregnancy) One or more aspects of metabolic syndrome, including[dummies.com]
  • Buffalo hump" – a mound of fat forms at the base of the neck Weight gain – especially in the abdomen while the arms and legs become skinny Increased body hair – especially on the arms, face, and around the belly button Thinning skin Acne Easy bruising Leg swelling[columbiasurgery.org]
  • The patient also had a complaint of swelling over face and all over the body since last 2 month. On examination the patient was febrile; tachycardia and tachypnea were also there.[ijem.in]
Increased Susceptibility to Infections
  • An increased susceptibility to infection may also lead to sepsis. Hyperglycemia and hypertension are a common association as it was there in this case. Osteoporosis is common and may cause pathological fracture.[ijem.in]
Hypertension
  • We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT.[ncbi.nlm.nih.gov]
  • Through the years it was not possible to confirm adrenal hyperfunction and the patient was treated considering very common symptoms (obesity, hypertension, osteoporosis ).[omicsonline.org]
  • Adrenal hyperfunction (Cushing syndrome) causes excess cortisol secretion by the adrenal gland and manifests in a constellation of symptoms, including central obesity, hypertension, type 2 diabetes, easy bruisability, abdominal striae, and myopathy.[arupconsult.com]
  • Examples include the use of insulin for diabetes and anti-hypertensive medications for high blood pressure. There are very few drugs that work by stopping the adrenal glands from making too much steroids.[endocrinediseases.org]
Hirsutism
  • It causes characteristic symptoms including obesity of the trunk and thinning of the extremities, a thickening at the base of neck called a buffalo hump, a rounding of the face, weakness of the proximal muscles, thinning of the skin, hirsutism or an increase[surgery.med.miami.edu]
  • Common signs and symptoms include central adiposity, roundness of the face or extra fat around the neck, thin skin, impaired short-term memory and concentration, irritability, hirsutism in women, fatigue, and menstrual irregularity. 4 Because each of[endocrinologyadvisor.com]
  • , Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, Co Durham DL 14 6AD, UK; s.nag{at}btopenworld.com Statistics from Altmetric.com adrenocortical carcinoma Cushing’s syndrome A 46 year old woman presented with a short history of hirsutism[pmj.bmj.com]
  • […] myopathy depression and other mood disorders osteoporosis hypertension hyperglycemia and development of overt diabetes mellitus immunosuppression and recurrent infections Female patients with Cushing syndrome may also have signs of androgen excess (e.g. hirsutism[radiopaedia.org]
  • Clinical Features  90 – 100 %  Central obesity  Rounded face (“moon face”)  Facial plethora  Decreased libido  70 - 90 %  Purple striae  Menstrual disturbances  Hirsutism  Erectile dysfunction  Hypertension  50 - 70 %  Muscle weakness  Posterior[slideshare.net]
Increased Hair Growth
  • Patients often present with increased hair growth (hirsuitism), increased muscle mass, acne and amenorrhea (loss of periods in a female). A feminizing adrenal tumor makes excess estrogen.[uofmhealth.org]
Skin Atrophy
  • atrophy, striae, and a predisposition to life-threatening infections. [3] Cushing syndrome is having multisystem presentation affecting every organ system.[ijem.in]
Papular Rash
  • She had large ecchymoses on her extremities and an erythematous, scaly, and papular rash in her inframam-mary creases and groin.[healio.com]
Osteoporosis
  • She was overweight (height 153 cm, weight 65 kg BMI 27), non-smoker, and suffered diffuse mild joint pain with osteoarthritis and osteoporosis.[omicsonline.org]
  • […] obesity of the trunk and thinning of the extremities, a thickening at the base of neck called a buffalo hump, a rounding of the face, weakness of the proximal muscles, thinning of the skin, hirsutism or an increase in hair, easy bruisability, depression, osteoporosis[surgery.med.miami.edu]
  • Hypercortiolism means a high level of the adrenal hormone cortisol, which causes many symptoms including weight gain, high blood pressure, diabetes, osteoporosis, concentration deficit and increased cardiovascular deaths.[sciencedaily.com]
  • Cushing’s disease or syndrome is often associated with significant morbidities, such as diabetes mellitus, cardiovascular disease, osteoporosis, reduced quality of life, and increased mortality. The following are the most common symptoms.[adrenaltumors.org]
  • Causes of Cushing's Syndrome Testing for Cushing's Syndrome Treatment of Cushing's Syndrome In 1932, a physician named Harvey Cushing described 8 patients with central body obesity, glucose intolerance, hypertension, excess hair growth, osteoporosis,[endocrineweb.com]
Muscle Weakness
  • Symptoms may include: upper body obesity round face increased fat around neck thinning arms and legs fragile and thin skin stretch marks on abdomen, thighs, buttocks, arms, and breasts bone and muscle weakness severe fatigue high blood pressure high blood[adrenaltumors.org]
  • Symptoms may include: Upper body obesity Round face Increased fat around neck or a fatty hump between the shoulders Thinning arms and legs Fragile and thin skin Stretch marks on abdomen, thighs, buttocks, arms, and breasts Bone and muscle weakness Severe[hopkinsmedicine.org]
  • weakness Mental fogginess Diagnosis Diagnosis of Cushing’s Syndrome Diagnosis is made by a series of blood, salivary, and sometimes urine tests along with imaging (workup of adrenal tumors).[saintjohnscancer.org]
  • Another test is used for patients who have high levels of cortisol but do not develop some of Cushing’s syndrome’s more progressive symptoms such as fractures of bone, muscle weakness, and skin thinning.[adrenalfatiguesolution.com]
Bone Pain
  • pain or tenderness Collection of fat between the shoulders and above the collar bone Rib and spine fractures caused by thinning of the bones Weak muscles, especially of the hips and shoulders Body-wide (systemic) changes include: Type 2 diabetes mellitus[medlineplus.gov]
  • Decreased IL-2 levels prevent the proliferation of T-lymphocytes. [9] History and Physical Patients may have a history of weight gain, fatigue, weakness, delayed wound healing, easy bruising, back pain, bone pain, loss of height, depression, mood swings[statpearls.com]
Decreased Libido
  • Clinical Features  90 – 100 %  Central obesity  Rounded face (“moon face”)  Facial plethora  Decreased libido  70 - 90 %  Purple striae  Menstrual disturbances  Hirsutism  Erectile dysfunction  Hypertension  50 - 70 %  Muscle weakness  Posterior[slideshare.net]
  • libido Decreased fertility Erectile dysfunction Other signs and symptoms that may occur with Cushing syndrome Severe fatigue Muscle weakness Depression, anxiety and irritability Loss of emotional control Cognitive difficulties New or worsened high blood[mayoclinic.org]
  • Other side effects include: headache, nausea, irregular periods, impotence, and decreased libido. Metyrapone can cause acne, hirsutism, and hypertension.[center4research.org]
Amenorrhea
  • It is characterized by upper body OBESITY; OSTEOPOROSIS; HYPERTENSION; DIABETES MELLITUS; HIRSUTISM; AMENORRHEA; and excess body fluid.[fpnotebook.com]
  • It is characterized by upper body obesity; osteoporosis; hypertension; diabetes mellitus; hirsutism; amenorrhea; and excess body fluid.[icd10data.com]
  • Hypothalamic amenorrhea 5. CBG excess (increased serum but not in urine cortisol) 42.[slideshare.net]
  • […] buffalo hump) Skin changes with easy bruising, purplish stretch marks (stria) and red cheeks (plethora) Excess hair growth (hirsutism) on face, neck, chest, abdomen, and thighs Generalized weakness and fatigue Loss of muscle Menstrual disorders in women (amenorrhea[pituitary.org]
  • Patients often present with increased hair growth (hirsuitism), increased muscle mass, acne and amenorrhea (loss of periods in a female). A feminizing adrenal tumor makes excess estrogen.[uofmhealth.org]
Headache
  • […] of Cushing syndrome) Periods that become irregular or stop Men may have: Decreased or no desire for sex (low libido) Erection problems Other symptoms that may occur include: Mental changes, such as depression, anxiety, or changes in behavior Fatigue Headache[medlineplus.gov]
  • […] changes Thinning of the skin Easy bruising Acne or superficial skin infections Purple striations on the skin of the abdomen, thighs, and breasts High blood pressure Weakness (often noticed when trying to stand up or to raise hand above head) Backache Headache[uclahealth.org]
  • He reports insomnia, headaches, leg weakness, decreased appetite, loss of smell, and chronic back pain.[endotext.org]
  • If you are experiencing these symptoms in combination with any of the other signs including fatigue, a new rise in blood pressure, emotional changes, or headaches, a trip to your doctor would be prudent.[adrenalfatiguesolution.com]
Limb Weakness
  • One month after surgery, the patient had persistent and severe symptoms of hypercortisolism, including proximal limb weakness and a swollen face. Her 24-h UFC was 1,046.72 μg/day, higher than previously determined.[ekjm.org]

Workup

  • Diagnosis is challenging, but an initial workup includes cortisol and dexamethasone suppression testing.[arupconsult.com]
  • […] particularly around the mid-section) Leg swelling Mood swings Irregular periods Muscle weakness Mental fogginess Diagnosis Diagnosis of Cushing’s Syndrome Diagnosis is made by a series of blood, salivary, and sometimes urine tests along with imaging (workup[saintjohnscancer.org]
  • […] be driven by increased secretion of hypothalamic corticotropin-releasing hormone, which is suppressed in Cushing's syndrome. 5 Causes and Diagnosis If Cushing's syndrome is suspected on the basis of the patient's physical appearance, the diagnostic workup[endocrinologyadvisor.com]
  • A low threshold for initiating a hypercortisolism workup should exist in these men with libido or erectile problems, low testosterone, and low gonadotropin levels.  Up to 50% of patients with Cushing syndrome exhibit urolithiasis; therefore stone formers[slideshare.net]
  • […] ovarian tumors adrenocorticotropin (ACTH)-independent macronodular adrenocortical hyperplasia (AIMAH) : rare cause of ACTH-independent Cushing syndrome 4 corticotropin-releasing hormone-secreting tumor: very rare hypothalamic tumors ectopic production The workup[radiopaedia.org]

Treatment

  • It could be a useful tool in this context because it might provide information to guide the treatment.[ncbi.nlm.nih.gov]
  • Management and treatment Treatment can be medical if aberrant adrenal receptors are identified and can be blocked (i.e. with propranolol, somatostatin or GnRH analogs).[orpha.net]
  • Treatment of overactive adrenal glands Treatment of overactive adrenal glands depends on the cause of the disease.[stanfordchildrens.org]
  • Other laboratory tests What is the treatment for Cushing's syndrome? Treatment for Cushing's syndrome depends on its cause. Surgery may be needed to remove tumors or the adrenal glands.[hopkinsmedicine.org]

Prognosis

  • Prognosis Prognosis after treatment is good but quality of life may be affected due to the long-term effects of hypercortisolemia. Without treatment the disease is life-threatening as in the case of manifest hypercortisolism.[orpha.net]
  • Expectations (prognosis): Patients with adrenal adenoma who undergo surgery have an excellent prognosis. Surgery success rates are very high with this type of tumor. For adrenal carcinoma, surgery is sometimes not possible.[uclahealth.org]
  • Follow Up Prognosis and Follow Up Over time, many of your symptoms should go away; weight loss, bruising, and face shape generally happen first. However, your body needs time to re-regulate itself, so these changes are not going to happen overnight.[saintjohnscancer.org]
  • Outlook (Prognosis) People with an adrenal tumor who have surgery have an excellent outlook. For adrenal cancer, surgery is sometimes not possible. When surgery is performed, it does not always cure the cancer.[ufhealth.org]

Etiology

  • Etiology The exact etiology is unknown but the adrenal overgrowth seen in AIMAH may be due to the expression of aberrant membrane receptors found in the adrenal cortex that regulate cortisol secretion and which are stimulated by gastric inhibitory polypeptide[orpha.net]
  • Epidemiological data, medical history, and hormonal parameters depending on the etiology of hypercortisolism were collected and compared to the duration of adrenal insufficiency.[ncbi.nlm.nih.gov]
  • Treatment and prognosis Management depends on the specific etiology 6.[radiopaedia.org]
  • […] granular to homogenous, due to accumulation of intermediate filaments Adrenal gland changes: exogenous cortisol causes low ACTH, which causes atrophy of fasciculata and reticularis, not glomerulosa, in residual or opposite adrenal gland Pathophysiology / etiology[pathologyoutlines.com]
  • ACTH-dependent cortisol excess due to a pituitary adenoma is called Cushing disease, and it is responsible for 80% of endogenous Cushing syndrome. [1] [2] [3] Etiology There are two main etiologies of Cushing syndrome: endogenous hypercortisolism and[statpearls.com]

Epidemiology

  • Summary Epidemiology Prevalence of endogenous CS is estimated at 1/26,000 and AIMAH represents less than 1% of the cases.[orpha.net]
  • Epidemiological data, medical history, and hormonal parameters depending on the etiology of hypercortisolism were collected and compared to the duration of adrenal insufficiency.[ncbi.nlm.nih.gov]
  • Cushing's syndrome: epidemiology and developments in disease management . Clin Epidemiol . 2015;7:281-293. doi:10.2147/CLEP.S44336 National Institutes of Health: Eunice Kennedy Shriver National Institute of Child Health and Human Development.[endocrinologyadvisor.com]
  • Cushing's syndrome: epidemiology and developments in disease management. Clin Epidemiol 2015; 7:281–293 [Google Scholar] 8. Steffensen C, Bak AM, Rubeck KZ, Jorgensen JO. Epidemiology of Cushing's syndrome.[ajronline.org]
  • Epidemiology and clinical manifestations of Cushing’s syndrome, 2014. UpToDate: Wolters Kluwer Health Cushing’s syndrome/ disease, 2013. American Association of Neurological Surgeons. Cushing’s syndrome, 2012.[center4research.org]
Sex distribution
Age distribution

Pathophysiology

  • A recent pathophysiological study showed that cortisol production was regulated by aberrant membrane receptors and by corticotropin produced within the adrenocortical tissue.[ekjm.org]
  • This chapter will focus on the pathophysiology, clinical presentation, evaluation and management of these disorders.[link.springer.com]
  • […] changes from granular to homogenous, due to accumulation of intermediate filaments Adrenal gland changes: exogenous cortisol causes low ACTH, which causes atrophy of fasciculata and reticularis, not glomerulosa, in residual or opposite adrenal gland Pathophysiology[pathologyoutlines.com]
  • Pathophysiology of disease: disorders of the hypothalamus & pituitary gland. Access Medicine Web site. . Accessed July 30, 2009. 7. Else T, Hammer GD, Lingappa VR. Disorders of the hypothalamus & pituitary gland. . Accessed July 14, 2009.[aboutcushings.com]

Prevention

  • Knowing this means that researchers might be able to develop drugs that interrupt the receptors for these hormones and possibly even prevent the benign tissue from developing in the first place.[sciencedaily.com]
  • Because glucocorticoids suppress the immune system, they reduce inflammation and are also frequently given to people who have had organ transplants to prevent the immune cells from attacking the transplant.[endocrinediseases.org]
  • Prevention: Use caution when taking corticosteroid medications. Appropriate treatment of adrenal tumors may reduce the risk of complications in some patients with tumor-related Cushing's syndrome.[uclahealth.org]
  • Prevention Appropriate treatment of adrenal tumors may reduce the risk of complications in some people with tumor-related Cushing syndrome. Images References Nieman LK, Biller BM, Findling JW, et al.[ufhealth.org]
  • Prevention Appropriate treatment of adrenal tumors may reduce the risk of complications in some people with tumor-related Cushing syndrome. References Nieman LK, Biller BM, Findling JW, et al.[mountsinai.org]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!