Cushing's syndrome may be a collection of signs and symptoms thanks to prolonged exposure to glucocorticoids like cortisol. Signs and symptoms may include high vital sign, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly. Women may have more hair and irregular menstruation. Occasionally there could also be changes in mood, headaches, and a chronic feeling of tiredness. Most cases are often treated and cured. If thanks to medications, these can often be slowly decreased if still required or slowly stopped. If caused by a tumor, it's going to be treated by a mixture of surgery, chemotherapy, and/or radiation. If the pituitary was affected, other medications could also be required to exchange its lost function. With treatment, anticipation is typically normal. Some, in whom surgery is unable to get rid of the whole tumor, have an increased risk of death.

Signs and Symptoms :

Symptoms include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity). Common signs include the expansion of fat pads along the collarbone, on the rear of the neck ("buffalo hump" or lipodystrophy), and on the face ("moon face"). Other symptoms include excess sweating, dilation of capillaries, thinning of the skin (which causes easy bruising and dryness, particularly the hands) and mucous membranes, purple or red striae (the weight gain in Cushing's syndrome stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs, or breasts, proximal muscle weakness (hips, shoulders), and hirsutism (facial male-pattern hair growth), baldness and/or extremely dry and brittle hair. In rare cases, Cushing's can cause hypocalcemia. the surplus cortisol can also affect other endocrine systems and cause, for instance , insomnia, inhibited aromatase, reduced libido, impotence in men, and amenorrhoea, oligomenorrhea and infertility in women thanks to elevations in androgens. Studies have also shown that the resultant amenorrhea is thanks to hypercortisolism, which feeds back onto the hypothalamus leading to decreased levels of GnRH release. Other signs include increased urination (and accompanying increased thirst), persistent high vital sign (due to cortisol's enhancement of epinephrine's vasoconstrictive effect) and insulin resistance (especially common with ACTH production outside the pituitary), resulting in high blood glucose and insulin resistance which may cause DM. Insulin resistance is amid skin changes like keratosis nigricans within the axilla and round the neck, also as skin tags within the axilla. Untreated Cushing's syndrome can cause heart condition and increased mortality. Cortisol also can exhibit mineralocorticoid activity in high concentrations, worsening the hypertension and resulting in hypokalemia (common in ectopic ACTH secretion) and hypernatremia (increased Na+ ions concentration in plasma). Furthermore, excessive cortisol may cause gastrointestinal disturbances, opportunistic infections, and impaired wound healing associated with cortisol's suppression of the immune and inflammatory responses. Osteoporosis is additionally a problem in Cushing's syndrome since osteoblast activity is inhibited. Additionally, Cushing's syndrome may cause sore and aching joints, particularly within the hip, shoulders, and lower back.
Most cases of Cushingoid symptoms are caused by corticosteroid medications, like those used for asthma, arthritis, eczema and other inflammatory conditions. Consequently, most patients are effectively treated by carefully truly fizzling out (and eventually stopping) the medication that causes the symptoms.

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Regards,
Alpine,
Managing Editor,
Archives of General Internal Medicine