Information on Cushing's syndrome

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Cushing's Syndrome
Cushing’s syndrome is an ailment marked by an endocrine disorder. This results in excess activity of the hormone androgen. Manifestations of Cushing’s syndrome include hirsutism (marked by unwanted and excess hair production on the upper lip, forehead and back), hypertension, a “buffalo” hump, purple striae, central obesity, a rounded face and proximal muscle infirmity.

Cushing’s syndrome is a rare cause of hirsutism, which is the growth of unwanted hair in females in an adult male pattern. It is the result of excess androgen action on hair follicles. The most prevalent cause of this hirsutism is polycystic ovary syndrome (PCOS). Other less prevalent endocrine-triggered causes of hirsutism include hyperandrogenism, hypothyroidism, hyperandrogenic insulin-resistant acanthosis nigricans syndrome (HAIR-AN), 21-hydroxylase non-classic I adrenal hyperplasia (late-onset CAH), 21 -hydroxylase-deficient congenital adrenal hyperplasia, hyperprolactinemia and androgenic tumors.

Cushing’s syndrome can be evaluated by medical examinations like a CT scan for review of the adrenal glands, a 24-hour urinary free cortisol and blood pressure tests. One can also go for a clinical investigation to check for an increased evening cortisol concentration and an absence of diurnal variation. But since this process is done by collecting blood samples at 8 am and then again at 11 pm, it is usually not too popular. However, if the tests come back positive, one needs to conduct further medical examinations to detect the true source of the condition. Generally, it is wise to check for the associated symptoms of this ailment before going in for a detailed medical examination.

One common test that is conducted if Cushing's syndrome is suspected is an overnight 1-mg dexamethasone suppression test. A positive outcome indicates the disease. Some cases of Cushing’s syndrome have developed as a result of drug treatments. Some psoriasis patients who applied 0.25% desoximetasone (a class II steroid) every day for a span of 5 years developed Cushing’s syndrome for example.

Treatment of endocrine-triggered ailments can be done by androgen suppression, peripheral androgen blockade combined with mechanical/cosmetic or topical removal and destruction of the unwanted hairs. It is also essential for obese hirsute patients to lose weight as well. In such patients, weight control helps by increasing the level of sex hormone binding globulin (SHBG) in their body and hence lessening free androgen levels.


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