Recent studies have shown that a relatively high number of diabetic patients may have unsuspected Cushing’s syndrome (CS).
Cushing’s syndrome is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. Sometimes called hypercortisolism,
Hypercortisolism refers to a range of conditions characterised by an excess of circulating corticosteroids.
Endogenous hypercortisolism is known as Cushing’s syndrome, and may arise from the adrenal cortex, e.g. because of an adrenal tumour, or may be secondary to overproduction of pituitary adrenocorticotrophic hormone (ACTH).
The most common cause of hypercortisolism is, however, steroid therapy.
Cushing’s syndrome is relatively rare and most commonly affects adults aged 20 to 50.
People who are obese and have type 2 diabetes, along with poorly controlled blood glucose and high blood pressure, have an increased risk of developing the disorder.
Signs and symptoms of Cushing’s syndrome vary, but most people with the disorder have upper body obesity, a rounded face, increased fat around the neck, and relatively slender arms and legs.
Children tend to be obese with slowed growth rates.
Other signs appear in the skin, which becomes fragile and thin, bruises easily, and heals poorly.
Purple or pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts.
The bones are weakened, and routine activities such as bending, lifting, or rising from a chair may lead to backaches and rib or spinal column fractures.
High blood pressure and high blood glucose levels (hyperglycemia) may commonly be experienced with Cushing’s syndrome.
Usage of corticosteroids is the most common cause of Cushing’s syndrome.
Corticosteroids are used to treat illnesses including:
Cushing’s syndrome can be diagnosed by measuring levels of cortisol in the urine, the blood or saliva.
You may be asked to take dexamethasone before the test is carried out.
If you don’t have Cushing’s syndrome, the dexamethasone should decrease your cortisol levels.
The treatment of Cushing’s syndrome depends upon the underlying cause.
When Cushing’s syndrome is caused by an ACTH-producing tumour ,the treatment can include:
Transsphenoidal surgery allows access to the base of the brain (where the pituitary is located), through the gums above the upper front teeth or the nose. If the tumour cannot be identified, the surgeon can remove half of the pituitary (hemihypophysectomy) or 85–90% of the gland (subtotal hypophysectomy). These treatments cause a loss of function of the pituitary so that the patient needs lifelong hormone replacement.
This can be used when the surgery cannot completely remove the tumour. The effects of radiation take 3–12 months to become apparent, so that medical treatment is required in the interim. These medications include ketoconazole, metyrapone and aminoglutethimide, which reduce the adrenal cortisol production.
This consists in surgical removal of the adrenal glands, but is recommended only if other treatments are not successful. The patient must begin lifelong daily glucocorticoid and mineralocorticoid replacement therapy.
When Cushing’s syndrome is caused by an ectopic ACTH-producing tumour, the treatment consists of the surgical removal of the tumour. This kind of tumour is often in the lung. If the surgery is not successful, medications that reduce adrenal cortisol production (ketoconazole, metyrapone and aminoglutethimide) can be used
When Cushing’s syndrome results from taking corticosteroids, the dosage you are taking will need to be reduced or stopped.
If you have been taking higher doses of steroids for a significant period of time, the dosage you take will usually be reduced before they can be stopped.
Some 20% of patients with Cushing’s syndrome have a diagnosis of diabetes, but insulin resistance and glucose intolerance develop in up to 80% of cases.
The prevalence of steroid-induced diabetes in the diabetic population is around 3%.
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