Cushings Syndrome: Causes and Symptoms

Cushings Syndrome Causes and SymptomsThe human physical structure is an plan of attack piece of machinery which possesses many organs and bodys that regulate the numerous processes that keeps every go against functioning to sustain universal life or Homeostasis. In the solution that any of these numerous processes occur unchecked with absolutely no dogmatic limits it results in a physiological disorder, syndrome or complaint each of these syndromes beat characteristic set up on the human anatomy which can be manifested physic onlyy of which some can be controlled or cured.Cushings syndrome, which is a hormonal disorder ca apply by the prolonged exposure of body tissues to spirited takes of the endocrine gland hydrocortis unitary and is frequently referred to as hyper hydrocortisoneism.Cushings syndrome is relatively r atomic number 18 and most ordinarily affects adults aged 20 to 50 years, citizenry who atomic number 18 obese and create type 2 diabetes, along with ailing controlled gunstock glucose also called blood sugar-and spunky blood pressure, slang an increased risk of take oning the disorder. cortisol is a very important internal secretion as job is to facilitate the body respond to stress. nearly people despicable from depression, alcoholism, malnutrition, or sc ar disorders also mystify increased cortisol levels.CausesPhysiologicalThe cause of Cushings syndrome is shared into two groups base upon whether the problem is being ca utilize by a spoiled hypophysis body gland gland gland, which is a small gland find on the dorsoventral side of the brain or by the adrenal glands which are located on the superior lopes of the kidneys. Cushings syndrome is caused when the bodys tissue are exposed laid-back volumes of the hormone cortisol for extremely long durations of time. Many individuals consume developed Cushings syndrome as a result of use or consumption of products that contain glucocorticoids. Glucocorticoids are s teroid hormones that are structurally similar naturally produced to cortisol e.g. prednisone, which is contained in most asthma, rheumatoid arthritis, lupus and other inflammatory disease medications. Glucocorticoids also fool properties which also al measly them to be used to suppress the immune system after organ or tissue transplants to keep the body from rejecting the sweet organ or tissue.Some people develop Cushings syndrome as a result of their bodies inability to produce adequate amounts of the hormone cortisol. The normally business of cortisol fol depresseds an exact and precise chain of events. In the hypothalamus, a federal agency of the brain the size of a small sugar cube, it releases corticotrophin psychotherapeutic hormone (CRH) to the pituitary gland. Corticotrophin causes the pituitary gland to secrete adrenocorticotrophin hormone (ACTH), which in returns stimulates the adrenal glands. When the adrenals, which are located just in a high place the superior l obes of the kidneys, receive the ACTH, they respond by releasing cortisol into the bloodstream. hydrocortisone is very important to the body because it is required to perform vital tasks in the body which include helping to maintain blood pressure and cardiovascular function, reduction of the immune systems inflammatory solution, the balancing of the effects of insulin, which breaks down glucose for zipper and the regulation of the metabolism of proteins, carbohydrates and fats. Cortisol is very important to the for its role in many processes only when its most important role is to help the body cope with stress and it is for this reason well trained athletes and pregnant women have high levels of the hormone circulating within their blood. In most cases individuals suffering from alcoholism, malnutrition and or panic disorders whitethorn also have increased cortisol levels. Under normal circumstances, when the cortisol levels are near normal levels the hypothalamus and pituitary release less CRH and ACTH. This ensures that the level of cortisol in the blood released by the adrenals is the exact balance to meet the bodys normal requirements.There are 4 common types of Cushings syndrome and each is caused by different factors e.g. pituitary adenomas, adrenal neoplasms, ectopic ACTH syndrome and Familial Cushings syndrome. Of the four different types of cushings syndrome, cases of familial cushings syndrome occurs more(prenominal) frequently. Most cases of familial cushings syndrome are non are not inherited genetically, and some cases are the result of gene which causes the development of tumors on one or more glands of the endocrine system which releases hormones into the bloodstream. There are some exceptions e.g. with primary pigmented micronodular adrenal disease, which is developed in children or young adults which develop small cortisol producing tumors on the adrenal glands. There are occurrences where seven-fold endocrine neoplasia type 1 (MEN), where hormone secreting tumors develop on the parathyroid glands, pancreas and pituitary.In cushings syndrome caused by adrenal tumors, an constipation of the adrenal glands causes the cushings syndrome. The adrenal tumor develops four to five times more in females than in males and begins at slightly at age forty. Most cases of adrenal tumors involve non crab louseous tissues of the adrenal glands and are called adrenal adenomas and are trusty for the release of additional cortisol into the blood. In the case of adrenocortical carcinomas, the cancerous form of adrenal tumors, the cancer cells release additional volumes of several types of adrenal androgens or male hormones which whitethorn include cortisol. The adrenocortical carcinomas are usually responsible for very high hormone levels and rapid development of symptoms.In Ectopic ACTH syndrome which is another(prenominal) cause of cushings syndrome, in some cases it is benign and in most caused by cancerous tumors that dev elop on the external surface of the pituitary and is subject of producing stimulative hormone. Lung tumors are known to be associated with increased risks of development of ectopic ACTH as it was present in more than half of all occurrences and is known to be more prevalent males than in females. The most fat form of adrenocorticotropic hormone producing tumors is minute cell lung cancer and accounts for approximately thirteen percent of all lung cancer cases and carcinoid tumors, which are small, slow evolution tumors that develop from hormone producing cells in various parts of the body. There are other less common types of tumors which possess the ability to produce adrenocorticotropic hormone e.g. thymomas, medullary carcinomas of the thyroid and pancreatic islet cell tumors.In most cases of Cushings syndrome seventy percent are caused by the development of pituitary adenomas and these statistics excluded instances where it is caused by glucocorticoid use. This type of benig n, or noncancerous tumor of the pituitary gland is responsible for the secretion of additional adrenocorticotropic hormone into the bloodstream. In most instances persons discomfit by this disorder have a single adenoma and is referred to as Cushings disease and it is known to affect women five more than men.Biochemical Diagnosis of Cushings syndromeTo appoint Cushings syndrome several factors are taken into consideration a person health check history, physical examinations and science laboratory exam. In diagnosing cushings syndrome the most commonly used runnel are the 24-hour urinary free cortisol render, measurement of midnight blood plasma cortisol or late night salivary cortisol and low dose dexamethasone downsizing test. In some instances an additional test dexamethasone corticotrophin releasing hormone test may be needed to differentiate Cushings syndrome from causes of excess.The 24 hour urinary cortisol level test consists of the collection of several urine sampl es over a 24 hour period and these samples are tested for cortisol. If the cortisol levels are higher than fifty to one hundred micrograms a day for an adult, this suggests that the individual has Cushings syndrome. From laboratory to laboratory the normal upper limit varies depending on which technique is used.The arcminute test that may be used to diagnose Cushings syndrome is Midnight plasma cortisol and late-night salivary cortisol measurements. This test measures cortisol concentrations in the blood. In normal individuals Cortisol production is normally restricted at night, but in Cushings syndrome, this restriction does not occur. If cortisol level in the individual is more than 50 nano-moles per liter (nmol/L), then the individual may have Cushings syndrome. This test usually requires a 48-hour hospital stay to avoid falsely magisterial cortisol levels due to stress.Another utilized I the diagnosis of Cushings is the Low-dose dexamethasone suppression test (LDDST). In this test, the individual is given a low dose of dexamethasone, which is a synthetic glucocorticoid, orally every 6 hours for 2 days. Urine samples are collected before dexamethasone is administered and several times on each day of the test. The modified Low-dose dexamethasone suppression test uses a onetime overnight dose. Cortisol and other glucocorticoids signal the pituitary to release less ACTH, so the normal response after taking dexamethasone is a drop in blood and urine cortisol levels. If cortisol levels do not drop, Cushings syndrome is suspected. In some instances Low-dose dexamethasone suppression test may not show a drop in cortisol levels in people with depression, alcoholism, high estrogen levels, acute illness, or stress, which will falsely indicate Cushings syndrome. In some instances, drugs such as phenytoin and phenobarbital may cause cortisol levels to drop, falsely indicating that Cushings is not present in people who actually have the syndrome and it is for this r eason, physicians usually give the sack their patients to stop taking these drugs at least 1 week before the test.The last test used to diagnose Cushings syndrome is the Dexamethasone-corticotrophin-releasing hormone (Crh) test. There are some exclusion to the rule as some individuals have high cortisol levels but do not develop the progressive effects of Cushings syndrome, such as muscle weakness, fractures, and thinning of the skin. These people may have pseudo-Cushings syndrome, which is a condition sometimes found in people who have depression or anxiety disorders, persons who drink alcohol excessively, have poorly controlled diabetes, or are severely obese. Pseudo-Cushings does not have the same semipermanent effects on health as Cushings syndrome and does not require intervention directed at the endocrine glands. The dexamethasone-CRH test is used to rapidly recognize pseudo-Cushing from mild cases of Cushings syndrome. This test combines the Low-dose dexamethasone suppress ion test and a CRH foreplay test. In the CRH stimulation test, an injection of CRH causes the pituitary gland to secrete ACTH. Pretreatment with dexamethasone prevents CRH from causing an increase in cortisol in people with pseudo-Cushing. Elevations of cortisol during this test suggest usually Cushings syndrome.Tests to Find the Cause of Cushings SyndromeOnce a positive diagnosis of Cushings syndrome has been obtained, other tests are performed to locate the cause of the abnormality that leads to excess cortisol production. The choice of test depends, in part, on the resource of the endocrinologist or the center where the test is performed.A CRH test is performed, without pretreatment with dexamethasone, this helps reissue people with pituitary adenomas from those with ectopic ACTH syndrome or adrenal tumors. As a result of the CRH injection, people with pituitary adenomas usually experience a stick up in blood levels of ACTH and cortisol because CRH acts directly on the pituita ry. This response is rarely seen in people with ectopic ACTH syndrome and practically neer in those with adrenal tumors.A high-dose dexamethasone suppression test (hDDST) may also be used as well. The A high-dose dexamethasone suppression test is the same as the LDDST, except it uses higher doses of dexamethasone. This test helps separate persons with excess ACTH due to pituitary adenomas from those with ectopic ACTH-producing tumors. A high dose of dexamethasone suppresses cortisol levels in people with pituitary adenomas but not in those with ectopic ACTH-producing tumors.Another test that may be used is radiological imaging of the endocrine glands. This test utilizes the use of computerized imagery (CT) and magnetic resonance imaging (MRI) to reveal the size and shape of the pituitary and adrenal glands to determine if a tumor is present. imaging tools are used to locate the tumor after a positive diagnosis of Cushings syndrome. Imaging is not used to make the diagnosis of Cus hings syndrome since benign tumors are commonly found in the pituitary and adrenal glands.