Highlands’ Newspaper - Thursday, April 10, 2008 - Page 13

Cushing Syndrome gets national attention

By Sally Hanson Reporter April 8 was the third-annual National Cushing’s Syndrome Awareness Day. Cushing’s Syndrome is the name given to any condition in which excess cortisol is present in the body. Further differentiations are made depending on the cause, but treatments are all aimed at bringing elevated cortisol and other affected hormones back within an acceptable range. The source of excess cortisol can be either an increased production by the adrenal glands or treatment with steroid medications. But why are cortisol levels important? While infomercials for diet pills have implicated cortisol as a stress hormone that causes people to store fat, it can be responsible for more than just bothersome weight gain. It helps the body regulate blood pressure, react to physical and emotional stressors, and properly metabolize food. Cortisol is produced by the adrenal glands. When the body senses a low level at the appropriate time of day, the hypothalamus in the brain secretes corticotropin releasing hormones to tell the pituitary gland to produce adrenocorticotropin hormone (ACTH). An increase in levels of ACTH is what actually initiates the production of cortisol by the adrenal glands. In a normal person, cortisol is secreted in a diurnal pattern with levels being the highest around 8 a.m. and being almost negligible around midnight. This helps maintain a relatively normal sleep-wake cycle, and it’s also a somewhat effective way to diagnose someone with a cortisol regulation disturbance because this diurnal rhythm is lost. These people tend to have higher cortisol levels at midnight, which can cause sleep disturbances, and lower-thannormal results for 8 a.m. tests. Anecdotally, people who work night shifts or establish different sleeping patterns can also experience a loss of diurnal rhythm. The effect of prolonged exposure to high corticosteroid levels on tissues throughout the body can be just as devastating in Cushing’s Syndrom, as uncontrolled blood sugar can be in diabetics. The three causes currently recognized as the most common for Cushing’s symptoms are tumors of the pituitary gland, tumors of the adrenal gland, and extended treatment with steroid medications. Many symptoms have been identified in Cushing’s patients, including central obesity in which most of the excess weight is carried in the torso and abdomen while the lower arms and legs are thinner in proportion. Patients can have a rounded face, swelling and water retention and thin skin that bruises easily and heals poorly. Pinkish-purple streaks on the skin that resemble stretch marks can appear on the abdomen, thighs, arms and lower back.

Women can show signs of androgenn excess in Cushing’s Syndrome. This includes symptoms like menstrual irregularities, acne, increased facial hair, and hair loss. While the physical symptoms are distressing enough, Cushing’s patients can also experience muscle weakness and muscle wasting, high blood pressure, osteoporosis, increased blood sugar or even type 2 diabetes, and headaches. Cognitive difficulties can also be a part of Cushing’s, often referred to as “brain fog.” Patients might have difficulty remembering things or concentrating. They are also more likely to suffer from anxiety, depression and emotional instability. Inhofe designates ‘National Cushing’s Syndrome Awareness Day’ April 8, 2008 U.S. Senator Jim Inhofe (R-Okla.) designation of April 8, 2008 as “National Cushing’s Syndrome Awareness Day.” Inhofe’s resolution (S. Res. 498) creating the designation passed the Senate by unanimous consent. Inhofe introduced this resolution to broaden public awareness and show his continued support for those suffering from this disease. “Cushing’s syndrome often goes undiagnosed or misdiagnosed, many times leading to death, because the initial symptoms are shared with a number of milder illnesses,” Inhofe said. “Since awareness is low, doctors do not always run the tests necessary for diagnosis, and patients do not know to ask for them. It is my hope that‘National Cushing’s Syndrome Awareness Day’ will help Oklahomans and everyone suffering with this disease to receive the best possible health care.” Cushing’s Syndrome is an endocrine or hormonal disorder. It is caused by over-exposure of the body’s tissue to high levels of the hormone cortisol. An estimated 10 to 15 people per million suffer from this debilitating disease. Common symptoms include abnormal weight gain, skin changes, fatigue, diabetes, high blood pressure, and depression. Over-production of cortisol is commonly associated with the treatment of asthma,rheumatoid arthritis, and lupus.Additionally, delayed treatment of Cushing’s Syndrome significantly reduces treatment options, such as radiation therapy. Thus, it is imperative that both doctors and patients heighten their awareness of Cushing’s Syndrome. For more information visit: www.CUSH.org

Unfortunately, due to the lack of public awareness and support in patients’own families, Cushing’s patients are often seen as lazy hypochondriacs who simply need to watch what they eat and exercise more. This perception can certainly contribute to mood swings and depression. The human endocrine system is made up of components all over the body, and because of its complexity any endocrine disorder can be difficult to diagnose. The main function of the endocrine system is to produce and regulate hormones that control many functions in the body. The nature of the endocrine system can make identifying the hormones that are out of balance especially difficult. Intricate positive and negative feedback loops control most of the hormone levels, and sometimes a particular hormone’s only function is to signal a certain gland to produce either more or less of another hormone. Therefore, even if you have a test result that is in range it doesn’t always mean that there isn’t a problem with the regulation of that particular hormone. Many hormones also fluctuate greatly over time, which makes the testing time an important piece in the puzzle. Cortisol levels can be measured in several different ways, including via blood samples, 24-hour urine collections and even saliva samples. The timing of these tests is crucial, and sometimes patients test for years before achieving diagnostic results. Treatment varies depending on the source of the cortisol excess. Tumors of the pituitary can be removed by a neurosurgeon using minimally-invasive techniques, and because most tumors aren’t at risk of spreading, much of the pituitary gland can be left in place to continue functioning. However, some patients with pituitary tumors don’t experience a cure and end up having repeat surgeries. Cushing’s patients with adrenal tumors often have one or both of the adrenal glands surgically removed. While this is curative in many cases, lifelong supplementation with the proper adrenal hormones is required. It is important to remember that many of the “symptoms” of Cushing’s Syndrome are common themselves and even if more than a few of them are evident in one person, it certainly doesn’t mean there is a serious endocrine disorder. Anywhere from 15-20% of people are discovered to have pituitary tumors upon autopsy, and most are benign and likely never caused the patient any symptoms. For more informatio, visit www.cush.org, the website of Cushing’s Understanding Support & Help Organization (CUSH). CUSH is a 501-C non-profit organization committed to bringing information regarding Cushing’s and its related illnesses into public awareness to help facilitate early diagnosis, treatment and recovery.