„Cushing's syndrome” – Causes, symptoms, therapy

Cushing's Syndrome arises due to prolonged excessive cortisol levels in the blood, leading to various adverse physiological changes characterized by distinct clinical manifestations. The adrenal corticotropic hormone (ACTH) is secreted by the pituitary gland and stimulates cortisol production by the adrenal glands. This stress hormone plays a crucial role in lipid, protein, and carbohydrate metabolism, as well as in modulating inflammatory responses and blood glucose regulation. In a healthy state, hormonal processes are self-regulated, but in Cushing's Syndrome, cortisol levels rise abnormally, resulting in decreased ACTH levels in the blood. It is essential to distinguish this condition from Cushing's disease, which is caused by excessive ACTH production by a pituitary tumor and results in similar symptoms.

Abnormal elevation of glucocorticoid secretion by the adrenal glands may arise from two distinct mechanisms: excessive ACTH stimulation or autonomous glandular activity. In the first scenario, the most prevalent cause of heightened adrenocorticotropic hormone levels is a pituitary microadenoma, distinguished by

The manifestations of Cushing's Syndrome are directly linked to prolonged excess cortisol levels in the body. Among the most characteristic symptoms are: fat accumulation in the facial, torso, and neck regions (buffalo hump), increased susceptibility to bruising, dermatological changes (red fissures, acne, predisposition to subcutaneous eruptions), muscle tissue breakdown, diminished muscle strength, osteoporosis leading to pathological fractures, hypertension, heightened vulnerability to infections—particularly fungal ones—metabolic disturbances (gout, hyperlipidemia, diabetes, thrombophlebitis), and endocrine disorders (hypothyroidism, growth retardation, menstrual irregularities, and sexual dysfunction).

The main objective of treatment is to normalize cortisol levels in the bloodstream and mitigate the symptoms of hypercortisolism. This can be accomplished through targeted pharmacotherapy, radiation therapy, or surgical intervention. The initial step in treatment involves a surgical procedure accessed through the sphenoid sinus. The aim of the procedure is to achieve the desired cortisol level within one week post-operation. Ideally, levels should not exceed 50 nmol/L, though studies indicate that values between 50 and 300 nmol/L also signify remission. If no improvement occurs post-procedure, a reoperation may be considered. In cases where reoperation is contraindicated, radiation therapy is employed instead. Epidemiological research confirms that radiation therapy effectively controls tumor progression and achieves remission in 75% of patients. Pharmacotherapy also serves as an effective method for reducing hypercortisolism symptoms. Commonly prescribed medications include adrenal steroidogenesis inhibitors such as mitotane, metyrapone, and ketoconazole.