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What is the impact of Cushing’s syndrome on obesity? – Part 1

What is Cushing Syndrome?

• Cushing’s syndrome describes the signs and symptoms associated with prolonged exposure to inappropriately high levels of the hormone cortisol.
• This can be caused by taking glucocorticoid drugs, or diseases that result in excess cortisol, adrenocorticotropic hormone (ACTH), or CRH levels.
• Cushing’s disease refers to a pituitary-dependent cause of Cushing’s syndrome: a tumor (adenoma) in the pituitary gland produces large amounts of ACTH, causing the adrenal glands to produce elevated levels of cortisol.
• It is the most common non-iatrogenic cause of Cushing’s syndrome, responsible for 70% of cases excluding glucocorticoid related cases.
• This pathology was described by Harvey Cushing in 1932.
• The syndrome is also called Itsenko-Cushing syndrome, hyperadrenocorticism or hypercorticism.
• Cushing’s syndrome is not confined to humans and is also a relatively common condition in domestic dogs and horses.
• It also occurs in cats, but rarely.
• It should not be confused with Cushing’s triad, a disease state resulting from increased intracranial pressure.
• Cushing’s syndrome is an endocrine, or hormone condition.
• It occurs when the body is exposed to high levels of the hormone cortisol for long periods of time.

Signs and symptoms of Cushing Syndrome on Obesity?

• Rapid weight gain: particularly of the trunk and face with sparing of the limbs (central obesity).
• A common sign is the growth of fat pads along the collar bone and on the back of the neck (buffalo hump) and a round face often referred to as a “moon face.”
• Hyperhidrosis (excess sweating).
• Telangiectasia (dilation of capillaries).
• Thinning of the skin (which causes easy bruising and dryness, particularly the hands) and other mucous membranes.
• Purple or red striae on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders), and hirsutism (facial male-pattern hair growth), baldness and/or extremely dry and brittle hair.
• In rare cases, Cushing can cause hypercalcemia, which can lead to skin necrosis.
• The excess cortisol may also affect other endocrine systems.
• Insomnia.
• Inhibited aromatase.
• Reduced libido.
• Impotence in men.
• Amenorrhoea/oligomenorrhea.
• Infertility in women due to elevations in androgens.
• Studies have also shown that amenorrhea is due to hypercortisolism, which feeds back onto the hypothalamus resulting in decreased levels of GnRH release.
• Patients frequently suffer various psychological disturbances, ranging from euphoria to psychosis.
• Depression and anxiety are also common.
• Other striking and distressing skin changes may appear in Cushing’s syndrome.
• Facial acne.
• Susceptibility to superficial dermatophyte and malassezia infection.
• Characteristic purplish, atrophic striae on the abdomen.

Other Signs include

• Polyuria (and accompanying polydipsia).
• Persistent hypertension (due to cortisol’s enhancement of epinephrine’s vasoconstrictive effect).
• Insulin resistance (especially common in ectopic ACTH production).
• Hyperglycemia (high blood sugar) and insulin resistance which can lead to diabetes mellitus.
• Insulin resistance is accompanied by skin changes such as:
– Acanthosis nigricans in the axilla and around the neck.
– Skin tags in the axilla.
– Hyperpigmentation.

Cortisol and the Endocrine system

• Cortisol is a hormone essential for life.
• It is involved in maintaining blood pressure and the immune system.
• It is also involved in the body’s handling of proteins, carbohydrates, and fats.
• It also helps the body respond to stress.
• Too much cortisol has negative effects on the body.

Usually, cortisol production is tightly regulated by the interactions of three parts of the endocrine system:
• A part of the brain called the hypothalamus (hy-po-THAL-mus) secretes corticotropin-releasing hormone (CRH).
• CRH signals gland attached to the brain, the pituitary gland, to release adrenocorticotropin (ACTH).
• ACTH signals the adrenal glands to make cortisol and release it into the bloodstream. The adrenal glands are a pair of organs located just above the kidneys in the abdominal cavity.
If something goes wrong with any of these glands or with the signaling system, the body may produce too much cortisol.

Cushing’s Syndrome Cushing’s Syndrome: Pathophysiology, Diagnosis and Treatment The Cushing’s Syndrome Diet

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