The rate of overweight and obesity is increasing year by year. With it then comes its good friends such as diabetes, high blood pressure and cholesterol problems. In the majority of the cases, the cause of obesity is contributed by caloric imbalance, specifically the calorie taken in by the body in terms of food exceeds that of the body’s daily needs. As such, it is not surprising that there is a gradually increasing weight throughout the years. However, in the minority of cases, hormonal imbalances may be the reason behind the increase in weight. We will discuss one of them here- Cushing’s syndrome - using a question and answer format.
Case:
A 48 year old female put on 15kg over the course of 2 years. She especially noticed that her tummy and face was bigger now. She felt tired easily and found that she bruised easily as well. She had squatted down to pick up some paper and found that she had difficulty standing again. She wonders if there is a hormonal imbalance that can cause this.
What is Cushing’s syndrome?
This is a condition where there is an excess of in steroids in the body causing several characteristic changes in the body.
How do you suspect someone of having Cushing’s syndrome?
See Table 1 for some of the characteristics of a person afflicted with this. These characteristics clustered together make up the syndrome. Though it should be noted that presence of the characteristics merely gives a suspicion of the syndrome and does not confirm it as many of the characteristics in the table are common and may have other causes.
Table 1: Suspicious characteristics that might point to Cushing’s syndrome
- Weight gain especially in the tummy and face
- Obesity
- Increased appetite
- Tiredness
- Decreased concentration and impaired memory
- Insomnia
- Thin skin with easy bruising
- Purplish stretch marks on the tummy
- Flush skin in cheeks
- Menstrual irregularities
- Weakness in limbs
- Worsening of control of current diabetes
- Worsening of current high blood pressure
- Increased susceptibility to infections
What is the cause of Cushing’s syndrome?
The vast majority of cases are due to the person taking in steroids such as in complementary medications that have been adulterated with steroids. Many times, these medications have been bought abroad or even online for pain and the user themselves are unaware of all the components. Long- term usage of the medications then causes Cushing’s syndrome and the various characteristics to develop. Hence it would be prudent for any user to beware and seek licensed medical attention for their illnesses.
In a minority of cases, the steroids are produced in excess from the body. Mostly this is due to a tumour in the pituitary gland, a small gland just beneath the brain and behind the nose, that produces in excess a command hormone known as ACTH. This command hormone then goes to the adrenal glands, the glands that sit on top of the kidney , and causes them to produce excess steroids. In rare cases, the source of the ACTH is from a cancer. The adrenal glands themselves may also harbour a tumour that produces excess steroids.
How to treat Cushing’s syndrome?
This depends on the cause of the disease. If this were due to external ingestion of complementary medication adulterated with steroids, then by stopping the offending medication, this should cure the condition. However, this is best done under supervision by an endocrinologist, the doctor who specialises in glands and hormones. They will first have to do a thorough examination and establish that the patient is indeed suffering from Cushing’s syndrome and then to determine the cause. This may be in the form of blood tests and scans of the pituitary or adrenals. The endocrinologist will also have to assess the consequences on the body of the excessive steroid intake such as diabetes, high blood pressure and even osteoporosis.
If it was due to drugs, the dosage and duration of the steroids have to be taken into account. This might not be easy in the case of complementary medications adulterated with steroids. The suspected medications might have to be sent for analysis of the component drugs. The doctor will then replace this with an equivalent amount of steroids and then commence a period of weaning off the steroids. The longer the duration the offending drug had been taken and the greater the amount, the longer the duration of the weaning off period will be. In rare cases, the steroids cannot be weaned off as the body’s own ability to produce their own steroids has been damaged.
If Cushing’s syndrome was caused internally, the best way forward would be to remove the offending cause, whether in the pituitary gland, the adrenal glands or the cancer.
Back to the case:
Her complaints are highly suspicious of Cushing’s syndrome. Upon further questioning, she related that she had obtained some drugs abroad for her knee pain and had continued to take it. This started 2 years ago and the time frame coincided with the start of her complaints. The drug was sent for analysis and came back adulterated with dexamethasone, a type of steroid. She was slowly weaned off the medication for the next about 6 months with a gradual decrease in her weight and also relieve of her Cushing’s related complaints. Her knee pain was also addressed as that was the reason that drove her to taking the offending drug initially.
