Conditions
Sarah Bekaert in Women's Health, 2018
Cushing’s syndrome – a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. The symptoms vary, but in most cases there is upper body obesity, a rounded face, increased fat around the neck, and thinning of the arms and legs. Other symptoms affect the skin, which becomes fragile and thin, bruises easily and heals poorly. Purplish-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 getting up from a chair may lead to backache and fractures of the rib and spinal column. In most cases there is severe fatigue, muscular weakness, high blood pressure and high blood sugar levels. Irritability, anxiety and depression are common. Women usually have excess hair growth on their face, neck, chest, abdomen and thighs, and their menstrual periods may become irregular or stop.
Neurological Manifestations of Medical Disorders
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Cushing’s syndrome is caused by adrenocortical hormonal excess. Some 70 per cent of naturally occurring Cushing’s syndrome is caused by corticotrophin-secreting pituitary tumours, usually microadenomas (this is Cushing’s disease). A few cases are due to ectopic production of adrenocorticotropic hormone (ACTH), most commonly from a small cell lung carcinoma. Some cases are ACTH-independent, most often arising from an adenoma or carcinoma of the adrenal gland. However, the most common cause of mild to moderate Cushing’s syndrome is iatrogenic, resulting from therapeutic use of corticostroids. or iatrogenic from corticosteroid excess. Pseudo-Cushing’s syndrome may arise from major depressive illness and from chronic alcoholism.
Endocrine diseases and pregnancy
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Clinical manifestations of Cushing’s syndrome include central obesity, moon-like plethoric face, dorsal cervical and supraclavicular fat pads, thin skin with easy bruising and wide, deeply recessed, reddish or violaceous striae, proximal muscle wasting and weakness, osteoporosis, and hirsutism. Hypokalemia, hypertension, and diabetes mellitus commonly complicate Cushing’s syndrome, but are not invariably present. Anovulatory oligomenorrhea and infertility frequently prevent pregnancy, so Cushing’s syndrome during pregnancy is an unusual occurrence. However, the presence of gonadotropin receptors in pigmented nodular adrenal hyper-plasia and in some adrenal adenomas may account for first expression of Cushing’s syndrome manifestations during pregnancy (69). When pregnancy does accompany Cushing’s syndrome, pre-eclampsia, hypertension, miscarriage, premature labor, intrauterine growth retardation, and stillbirth are distinct risks (58,70). However, neonatal ACTH suppression and adrenal insufficiency are rare, and fetal virilization does not occur. Thus, most therapeutic attention and diagnostic efforts are directed toward maternal health during the pregnancy.
Clémentine Delait (1865–1934), the most famous bearded lady on the continent in the 20th century
Published in Gynecological Endocrinology, 2020
We can only speculate on the cause of the hirsutism in Clémentine Delait. She developed hirsutism at the age of 18 and died at the age of 69. She also showed subtle other signs of hyperandrogenism like her muscular power and she had a deep voice as well. On the other hand she was morbidly obese (BMI 36 kg/m2). She never became pregnant. She died of a cardiovascular - thromboembolic event. There were no other reported signs or symptoms of Cushing’s syndrome (like: rounded (moon) face, peripheral muscular atrophy, easy bruisability, edema, or psychiatric/psychologic symptoms). These combinations do not fit with the diagnosis of Cushing’s syndrome, nor with malignant disorders accompanied by hyperandrogenism, such as ovarian and adrenal tumors. The most probable diagnosis in this case still remains PCOS [12]. The obesity and cardiovascular problems fit well with this diagnosis. A second possibility is an incomplete block in the adrenal steroid synthesis (CAH), like nonclassical 21-hydroxylase (21OHD) deficiency [13].
Peripheral clock system circadian abnormalities in Cushing’s disease
Published in Chronobiology International, 2020
Vinicius Reis Soares, Clarissa Silva Martins, Edson Zangiacomi Martinez, Leonardo Domingues Araujo, Silvia Liliana Ruiz Roa, Lucas Ravagnani Silva, Ayrton Custodio Moreira, Margaret De Castro
We studied 13 healthy women and 12 CD patients. Patients were investigated between 2015 and 2017 in the Division of Endocrinology at HCFMRP-USP, one of the referral services for Cushing’s syndrome in Brazil. The diagnosis of Cushing’s syndrome was based on clinical signs and symptoms and subsequent confirmation of hypercortisolism by biochemical testing, according to international established criteria (Nieman et al. 2008). Briefly, biochemical diagnosis was based on increased levels of urinary-free cortisol and/or late-night salivary cortisol (LNSC), and non-suppression of plasma or salivary cortisol after low-dose (1 mg overnight) dexamethasone suppression test (LDDST). To diagnose endogenous hypercortisolism, we used as a cutoff for LNSC values above 350 ng/dL (or 9.8 nmol/L) and salivary cortisol levels after LDDST above 150 ng/dl (or 4.2 nmol/L) (Elias et al. 2014). The criteria for a normal salivary cortisol circadian rhythm was late-night cortisol (2300 h) lower than 83.5% of morning basal cortisol (0900 h) and lower than 350ng/dl (9.65 nmol/l) (Castro et al. 1999). Values below the limit of detection of the method, for statistical analysis, were substituted by the limit of detection.
Adrenocortical carcinoma arising from the colonic mesentery
Published in Baylor University Medical Center Proceedings, 2022
Samuel Z. See, Sinan Ali Bana, Nuvaira Ather, Amy Haberman
Clinical presentation depends on whether the tumors are functioning or nonfunctioning. Patients with functioning tumors typically present with symptoms of the Cushing syndrome and/or virilization.8 Many nonfunctioning tumors are detected incidentally on radiographic studies performed for another reason. Imaging generally shows an inhomogeneous hypervascular tumor with irregular margins with or without necrosis and hemorrhage.9,10 Biopsy and subsequent histopathologic evaluation are required for diagnosis. Immunohistochemistry findings of positive alpha-inhibin, Melanin-A, and SF-1 can confirm the primary adrenal origin.11 The Modified Weiss Criteria use histopathologic characteristics to differentiate an adrenal adenoma from carcinoma. These characteristics include a mitotic rate >5 per 50 high-power fields, clear cytoplasm compromising ≤25% of the tumor, abnormal mitoses, necrosis, and capsular invasion, with each criterion receiving a score of 0 when absent and 1 when present. Using the formula 2× mitotic rate criterion + 2× clear cytoplasm criterion + abnormal mitoses + necrosis + capsular invasion, a score of 3 or more suggests malignancy.12
Related Knowledge Centers
- Acne
- Cortisol
- Glucocorticoid
- Lipodystrophy
- Muscle Weakness
- Osteoporosis
- Hypertension
- Abdominal Obesity
- Stretch Marks
- Moon Face