Cushing's syndrome or hypercortisolism is an endocrine disorder caused by excessive levels of the endogenous In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. Glucocorticoids such as cortisol control... corticosteroid Hormone is also the NATO reporting name for the Soviet/Russian Kamov Ka-25 military helicopter. A hormone (from Greek horman - to set in motion) is a chemical messenger from one cell (or group of cells) to another. All multicellular organisms (including plants) produce hormones. The best known hormones are... hormone Cortisol (hydrocortisone, C21H30O5 ), is a corticosteroid hormone synthesized in the zona fasciculata of the cortex of the adrenal glands. Its systematic name is 11ß,17,21-Trihydroxypregn-4-ene-3,20-dione and its CAS number is 50-23-7. The molcular weight is approximately 362.47. The amount of... cortisol. It may also be induced An iatrogenic (pronounced [aI%{.tr@UdZE.nIk], SAMPA) condition is a state of ill health or adverse effect caused by medical treatment, usually due to mistakes made in treatment. The word literally means caused by a doctor (iatros means physician in Greek), though such conditions can be the fault... iatrogenically by treatment with exogenous In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. Glucocorticoids such as cortisol control... corticosteroids for other medical conditions.

Signs and symptoms

Symptoms include Obesity is an excess storage of fat and can affect any mammal, such as the mouse on the left. Obesity is a condition in which the natural energy reserve of a mammal (such as a human), which is stored in fat, is expanded far beyond usual levels to the point... weight gain, particularly of the trunk and face with sparing of the limbs ( Central obesity (or apple-shaped or masculine obesity), is when the main deposits of body fat are localised around the abdomen and the upper body. Associations Central obesity is common in polycystic ovary syndrome (PCOS) and Syndrome X, and it is associated with a statistically higher risk of heart disease... central obesity), "moon face", excess Sweating (also called perspiration or sometimes transpiration) is the loss of a watery fluid, consisting mainly of sodium chloride and urea in solution, that is secreted by the sweat glands in the skin of mammals. Sweat also consist of the chemicals or odorants 2-methylphenol and 4-methyphenol. In humans... sweating, atrophy of the skin (which gets thin and bruises easily) and other mucous membranes, purple striae on the trunk and legs, proximal muscle weakness (hips, shoulders), and Hirsutism is the excessive growth of hair, particularly on a womans face, torso and limbs, and is generally caused by increased androgens. It is a common sign of polycystic ovary syndrome in women. It can also be caused by a pituitary tumour or other serious medical conditions. One method... hirsutism (male-pattern hair growth). The excess cortisol may also affect other endocrine systems and cause, for example, reduced For the Peruvian rock group, see Libido (band). Libido in its common usage means sexual desire, however more technical definitions, such as found in the work of Carl Jung, are more general, referring to libido as the free creative, or psychic, energy an individual has to put toward personal development... libido, Impotence or, more clinically, erectile dysfunction is the inability to maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. The recent introduction of effective medication has increased awareness of this previously little-appreciated disorder. (Note: The Latin term impotentia coeundi describes simple inability... impotence, Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. Physiologic states of amenorrhoea are seen during pregnancy and lactation (breastfeeding). Outside of the reproductive years there is absence of menses during childhood and after menopause. Etymology and definition The term is... amenorrhoea and Infertility is the inability to naturally conceive, carry or deliver a healthy child. The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile if they have not conceived after a year of unprotected intercourse in women under 35, or after six months in women over 35... infertility. Patients frequently suffer various psychological disturbances, ranging from Euphoria may refer to: A psychological state of intense good feeling Euphoria (band), a psychedelic music group. Euphoria (1997 album), an album by Leftover Salmon Euphoria (1999 album), an album by Def Leppard Euphoria programming language This is a disambiguation page — a navigational aid which lists other pages that... euphoria to frank Psychosis is a psychiatric classification for a mental state in which the perception of reality is distorted. Persons experiencing a psychotic episode may experience hallucinations (often auditory or visual hallucinations), hold paranoid or delusional beliefs, experience personality changes and exhibit disorganized thinking (see thought disorder). This is sometimes accompanied by... psychosis.

Signs include persistent In medicine, hypertension refers to the problem of abnormally high blood pressure. There are three main types of hypertension, namely: arterial hypertension - with an elevated blood pressure in the systemic circulation pregnancy-induced hypertension is newly diagnosed arterial hypertension in pregnant women. It requires close monitoring pulmonary hypertension - with an... hypertension (due to the Aldosterone is a steroid synthesized in the mid-section of the adrenal cortex of the adrenal gland. It is the sole endogenous member of the class of mineralocorticoids. It helps regulate the bodys electrolyte balance by acting on the mineralocorticoid receptor (MR). Unlike neuroreceptors, classic steroid receptors are located... aldosterone-like effects) and In medicine, insulin resistance denotes a decompensation of glucose homeostasis where the tissues appear to be less responsive to insulin. Pathophysiology In patients who use insulin, insulin resistance is production of antibodies against insulin that lead to lower-than-expected falls of glucose levels after a given dose of insulin... insulin resistance, leading to Hyperglycemia is the condition of having an excessive amount of glucose circulating in the blood plasma. Etymology hyper- in Greek meaning too much; -glyc- in Greek meaning sweet; -emia meaning of blood. It is the basic and most consistent finding in all types of diabetes mellitus. In fasting adults blood... hyperglycemia (high In medicine, blood sugar is glucose in the blood. Blood sugar concentration is an important factor in diabetes. Regulation Blood sugar levels are regulated by negative feedback in order to keep the body in homeostasis. The levels of glucose in the blood are monitored by the pancreas, when the concentration... blood sugars); many develop frank This article is about the disease that features high blood sugar. The other major but far less common diabetes is diabetes insipidus (water diabetes, DI). Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (elevated blood sugar levels), especially after eating. All types of diabetes mellitus share... diabetes).

Diagnosis

When Cushing's is suspected, both a Dexamethasone is a synthetic member of the glucocorticoid class of hormones. It is about 40 times stronger than hydrocortisone. Therapeutic use Dexamethasone is used therapeutically in many, mainly inflammatory and autoimmune conditions. It is also given to cancer patients undergoing chemotherapy, to counteract certain side-effects of their antitumor treatment... dexamethasone suppression test (administration of dexamethasone and frequent determination of cortisol and ACTH levels) and 24-hour urinary measurement for cortisol have equal detection rates. A novel approach is sampling cortisol in For the band, see Saliva (band). In animals, saliva is produced in and secreted from the salivary glands. It is a fluid containing: water electrolytes mucus and various enzymes. In human saliva, amylase starts the digestion of starch before the food is even swallowed. It has a pH of 7... saliva over 24 hours, which may be equally sensitive. Other screening blood tests commonly performed are a A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. Automated blood count Blood for a FBC is usually taken into an EDTA tube to stop it from... full blood count, An electrolyte is a substance which dissociates free ions when dissolved (or molten), to produce an electrically conductive medium. Because they generally consist of ions in solution, electrolytes are also known as ionic solutes. They are sometimes referred to in abbreviated jargon as lytes. Electrolytes generally exist as acids, bases... electrolytes, In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. Indirect markers Most doctors use creatinine, urea and electrolytes to determine renal function. These measures are adequate to determine whether a patient is suffering from kidney disease. Glomerular filtration rate In... renal function and Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. Most liver diseases cause only mild symptoms initially, while it is vital that these diseases are detected early... liver enzymes. Other pituitary hormones may need to be determined, and determining the Your field of view is that part of the observable world that you are able to see at any given moment. Different animals have different fields of view, depending on the placement of the eyes. Humans have a 180-degree forward-facing field of view, while some birds have a... visual field may be necessary if a pituitary lesion is suspected (which may compress the The optic nerve is the nerve that transmits visual information from the retina to the brain. Anatomy The nerve is the second of twelve paired cranial nerves but is usually considered to be part of the central nervous system as it is derived from an outpouching of the diencephalon during... optic nerve).

When these tests are positive, CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... CT scanning of the adrenal gland and For other meanings see Magnetic Resonance Imaging (MRI). The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. Their culture appears to be drawn upon those of the Apache, Arabs, and Japanese samurai. Their name means simply the People, and all other races are... MRI of the Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea that sits in the small, bony cavity (sella turcica) at the base of the brain... pituitary gland are performed. These should be performed when other tests are positive, to decrease likelihood of In medicine, an incidentaloma is a tumor (-oma) found by coincidence (incidental) without clinical symptoms and suspicion. It is a common problem: up to 7% of all patients over 60 may harbor a benign growth, often of the adrenal gland, which is detected when diagnostic imaging is used for the... incidentalomas (incidental discovery of harmless lesions in both organs). Nuclear medicine is the branch of medicine that uses unsealed radioactive substances in diagnosis and therapy. It may also be referred to as radionuclide imaging or nuclear scintigraphy. Within nuclear medicine there are a wide variety of investigations and therapies, all of which involve the administration of one or more... Scintigraphy of the adrenal gland with iodocholesterol scan is occasionally necessary. Very rarely, determining the cortisol levels in various veins in the body (employing catheterisation) is necessary.

Pathophysiology

Cortisol (hydrocortisone, C21H30O5 ), is a corticosteroid hormone synthesized in the zona fasciculata of the cortex of the adrenal glands. Its systematic name is 11ß,17,21-Trihydroxypregn-4-ene-3,20-dione and its CAS number is 50-23-7. The molcular weight is approximately 362.47. The amount of... Cortisol is secreted by the In mammals, the adrenal glands are the triangle-shaped endocrine glands that sit atop the kidneys. They are chiefly responsible for regulating the stress response through the synthesis of corticosteroids and catecholamines, including cortisol and adrenalin. Overview Anatomically, the adrenal gland is situated on the anteriosuperior aspect of the kidney... adrenal glands under regulation by the Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea that sits in the small, bony cavity (sella turcica) at the base of the brain... pituitary gland and In the anatomy of mammals, the hypothalamus is a region of the brain located below the thalamus, forming the major portion of the ventral region of the diencephalon and functioning to regulate certain metabolic processes and other autonomic activities. The hypothalamus links the nervous system to the endocrine system by... hypothalamus. Strictly, Cushing's syndrome refers to excess cortisol of any etiology. Cushing's disease refers only to hypercortisolism secondary to excess production of adrenocorticotropin ( Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ACTH stimulates the cortex of the adrenal gland and boosts the synthesis of corticosteroids, mainly glucocorticoids but also mineralcorticoids... ACTH) from a Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea that sits in the small, bony cavity (sella turcica) at the base of the brain... pituitary gland Adenoma refers to a collection of growths (-oma) of glandular origin. Adenomas can grow from many organs including the colon, adrenal, pituitary, thyroid, etc. These growths are benign, but some are known to have the potential, over time, to transform to malignancy. Colon Adenomas of the colon are quite prevalent... adenoma.

Therapy

If an adrenal Adenoma refers to a collection of growths (-oma) of glandular origin. Adenomas can grow from many organs including the colon, adrenal, pituitary, thyroid, etc. These growths are benign, but some are known to have the potential, over time, to transform to malignancy. Colon Adenomas of the colon are quite prevalent... adenoma is identified it may be removed by surgery. Post-operatively most patients will require steroid replacement at least in the interim as long-term suppression of pituitary ACTH and normal adrenal tissue does not recover immediately. Clearly, if both adrenals are removed replacement with Hydrocortisone is a synthetic corticosteroid drug which may be given by injection or by topical application. It is given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients who need steroid treatment but cannot take oral medication, and peri... hydrocortisone or Prednisolone is a synthetic corticosteroid drug which is usually taken orally and can be used for a large number of different conditions. It has a mainly glucocorticoid effect. The related substance prednisone is a pro-drug that is converted by the liver into prednisolone, which is the active drug. Prednisolone... prednisolone is imperative.

In those patients not suitable for or unwilling to undergo surgery, several drugs have been found to inhibit cortisol sythesis (e.g. Ketoconazole is a synthetic antifungal drug used to prevent and treat skin and fungal infections, especially in immunocompromised patients such as those with AIDS. Due to its side-effect profile, it has been superseded by newer antifungals, such as Fluconazole and Itraconazole. It is sold commercially as Nizoral by Janssen... ketoconazole, Metyrapone (Metopirone™) is a drug used in the diagnosis, and occasionally the treatment, of Cushings syndrome (hypercortisolism). When excess ACTH secretion is the cause of hypercortisolism, the metyrapone test helps clarify if the source of the ACTH is pituitary or ectopic (non-pituitary). Categories: Pharmacologic agents ... metyrapone) but they are of limited efficacy.

In iatrogenic Cushing's, dose adjustment may be sufficient or it may be necessary to change to another type of immunosuppresive medication.

Epidemiology

An iatrogenic (pronounced [aI%{.tr@UdZE.nIk], SAMPA) condition is a state of ill health or adverse effect caused by medical treatment, usually due to mistakes made in treatment. The word literally means caused by a doctor (iatros means physician in Greek), though such conditions can be the fault... Iatrogenic Cushing's syndrome (caused by treatment with In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. Glucocorticoids such as cortisol control... corticosteroids) is the most common form of Cushing's syndrome. Endogenous (i.e. non-iatrogenic) Cushing's syndrome is relatively rare.

Incidence of causes of Cushing's syndrome per million person-years: -

• Cushing's disease: 10
• Primary adrenal: 3
• Ectopic ACTH: 1.4

See also

The converse situation of primary adrenal insufficiency is known as Addison's Disease--which afflicted Order: 35th President Vice President: Lyndon B. Johnson Term of office: January 20, 1961 – November 22, 1963 Preceded by: Dwight D. Eisenhower Succeeded by: Lyndon B. Johnson Date of birth: May 29, 1917 Place of birth: Brookline, Massachusetts Date ... John F. Kennedy.

External links

• Cushing's Syndrome (http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm)
• Cushing's syndrome (http://www.surgical-tutor.org.uk/default-home.htm?system/hnep/cushings.htm~right)
• Cushing's Syndrome/Disease in dogs (http://www.io.com/~lolawson/cushings/)
• Cushing's Syndrome and Cushing's Disease (http://cushings.homestead.com/)