Cushing syndrome occurs due to excessive cortisol levels in the body, resulting in symptoms such as weight gain, a rounded face, and high blood pressure. It can be caused by overuse of glucocorticoids or tumors affecting cortisol production, and diagnosis often involves hormone level testing and imaging. Treatment options include medications to control cortisol production, surgical interventions for tumors, and lifestyle modifications to manage symptoms.

1. Cushing
syndrome
By
P.Jyothi
Pharm D
Geethanjali college of pharmacy.

3. Introduction
Cushing syndrome happens when the body has too much of the
hormone
cortisol for a long time. This can result from the body making too
much
cortisol, or from taking medicines called glucocorticoids, which
affect
the same way as cortisol.
Too much cortisol can cause some of the main
symptoms of Cushing syndrome — a fatty hump between the
shoulders,
a rounded face, and pink or purple stretch marks on the skin.
Cushing syndrome also can cause high blood pressure or bone
loss.

5. Etiology
Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in
the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s
syndrome), excess production of cortisol from a tumor in the adrenal gland or
elsewhere in the body (ectopic Cushing’s syndrome) or a tumor of the pituitary
gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-
production of cortisol from the adrenal gland.
Cushing syndrome is caused by having too much cortisol in the body.
Cortisol is a hormone that is made in the adrenal glands. It helps the body
respond to stress and plays many other important roles, including:
Controlling blood pressure.
Reducing inflammation.
Helping the heart and blood vessels work correctly.
Controlling blood sugar.
Helping the body use food for energy.

7. Pathophysiology
Cushing disease the frequency of ACTH production remains the same,
but the normal circadian rhythm is lost. The increased plasma ACTH
causes bilateral adrenal hyperplasia and a consequent increase in the
production of cortisol. Therefore, the normal circadian rhythm of cortisol
is also lost.
Cortisol functions primarily as a glucocorticoid; however, in high
concentrations, cortisol can also exhibit mineralocorticoid activity,
leading to hypertension and hypokalaemia through the renin-
angiotensin-aldosterone system (RAAS).The RAAS hormone system
regulates plasma sodium concentrations as well as arterial blood
pressure, which can indirectly lead to hypokalaemia.

9. Signs and Symptoms
• Common symptoms of Cushing syndrome
• Weight gain in the trunk, with thin arms and legs.
• Weight gain in the face. This is sometimes called moon face.
• A fatty lump between the shoulders. This may be referred to as a buffalo hump.
• Pink or purple stretch marks on the stomach, hips, thighs, breasts and
underarms.
• Thin, frail skin that bruises easily.
• Slow wound healing.
• Acne.
Symptoms women with Cushing syndrome
• Thick, dark hair on the face and body. This condition is called hirsutism.
• Periods that are irregular or that stop.
Symptoms men with Cushing syndrome
• Lower sex drive.
• Reduced fertility.
• Problems getting an erection.

10. Other possible symptoms
of Cushing syndrome
1. Extreme tiredness.
2. Muscle weakness.
3. Depression, anxiety and irritability.
4. Emotions that are hard to control.
5. Trouble concentrating or remembering.
6. Sleeplessness.
7. High blood pressure.
8. Headache.
9. Infections.
10. Skin darkening.
11. Bone loss, which can lead to broken bones.
12. Stunted growth in children.

11. Diagnosis
Urine and blood tests. These tests measure hormone levels and show if the
body is making too much cortisol. For the urine test, you may be asked to collect
your urine over a 24-hour period. Cortisol, ACTH and other hormones are be
measured in urine and blood samples.
Saliva test. Cortisol levels typically rise and fall during the day. In people without
Cushing syndrome, cortisol drops in the evening. By looking at cortisol levels from
a small sample of saliva collected at night, the health care team can see if cortisol
levels are too high.
Imaging tests. CT or MRI scans can take pictures of the pituitary and adrenal
glands to see if anything shows up, such as tumors.
Inferior petrosal sinus sampling. This test can help decide if Cushing syndrome is
caused by an ACTH-producing pituitary adenoma, or ACTH-producing tumor in
another organ. For the test, blood samples are taken from the veins that drain the
pituitary gland, called the inferior petrosal sinuses.

13. Complications

14. Treatment
Medicines to control cortisol production at the adrenal gland include ketoconazole,
osilodrostat (Isturisa), mitotane (Lysodren), levoketoconazole (Recorlev), and
metyrapone (Metopirone).
Exogenous corticosteroid use
Taper steroid dose down and wean patient off
Pituitary tumor
Resection of the tumor (transsphenoidal resection)
Adrenal tumor
Partial or total adrenal resection (adrenalectomy)
Chemotherapy, radiation, etc. If malignant
Ectopic ACTH-producing tumor
Resection depending on the site

15. Patient counselling

16. Patient counselling
1. Reduce sodium intake - excess sodium can worsen symptoms of the
syndrome by increasing BP and cusging weight gain.
2. Increasing calcium intake and vit d3 – which strengthen the bones
include kale, cheese and broccoli, milk and beverages fortified with vit
D
3. Reducing cholesterol- avoid fatty foods and eat more fibrous foods.
4. Reducing or eliminating tobacco – tobacco increase the risk of
complications.
5. The exercises like swimming and bicycling which is not stress full to
Skeletal muscles.
6. Maintaining the muscle with high protein – beans, lean meat, etc...
7. Foods rich in magnesium which increases the cortisol level like
processed meats, high sugar foods and caffeine and alcohol.
8. Do not stop the corticosteroid use abruptly and without medical
supervision.
9. Relaxing in quiet environment for rest and sleep.
10. Use meticulous skin care to avoid traumatized fragile skin.

17. Reference
• https://www.medlineplus.in
• https://www.pubmed.in
• https://www.NIH.gov.in.