Cushings Syndrome - Term Paper Example

Cushing’s Syndrome According to Dr. Lewis Blevins, medical director of the California Center for Pituitary Disorders at UCSF Medical Center, 1 out of 5 people may be suffering from pituitary tumor, or the tumor that causes Cushing’s syndrome, but only 18 out of 100,000 people would think of having an MRI scan because only a few people would think that their headache, weight gain, erectile dysnfunction or irregular menstruation is caused by a pituitary tumor (Interview with Dr. Lewis Blevins, 2010). For every 1 million people annually who are suffering from Cushing’s Syndrome, the survival rate is only 4.6 years. The person with Cushing’s Syndrome usually dies from cerebrovascular accident, myocardial infarction, or other infectious complications (Nieman et al., 2008). Definition Cushing’s Syndrome is a disorder involving the hormones and is particularly caused by an abnormal increase in the amount of the hormone cortisol or other glucocorticoid hormones in the blood (Nieman et al., 2008). In the case of an overactive immune system, glucocorticoids usually turn down the inflammation system as a sort of negative feedback mechanism. However, if there is too much production of glucocorticoids, especially cortisol, in the blood, then the entire immune system might be turned down, thus leading to a variety of numerous physiological disturbances known as Cushing’s syndrome (Nieman et al., 2008). Causes The main cause of Cushing’s syndrome is the overproduction of adenocorticotropic hormone, or ACTH, by the pituitary gland, which is usually known as Cushing’s Disease. Another cause is an adrenal gland tumor that usually occurs among women over 40 years of age. A third cause is a tumor somewhere in the body which either produces too much cortisol or causes its production, such as tumors in the pancreas, lungs or thyroid that oversecrete ACTH (Nieman et al., 2008). The overproduction of ACTH by the pituitary gland causes the production of excessive cortisol by the adrenal glands. An alternative initial step would be an excess of corticotrophin-releasing hormone, or CRH, from the hypothalamus causing the pituitary gland to produce excessive ACTH (Nieman et al., 2008). However, the most initial step for Cushing’s syndrome is the ACTH stimulating the adrenal glands for the production of cortisol (Blevins, 2002). Symptoms Cushing’s Syndrome is characterized by “reddish purple striae, plethora, proximal muscle weakness, bruising with no obvious trauma, as well as unexplained osteoporosis” (Nieman et al., 2008). Other symptoms of the disease include “obesity, depression, diabetes, hypertension, or menstrual irregularity” (Nieman et al., 2008). If Cushing’s Syndrome affects the higher brain centers in the case of complications, it may cause anxiety disorder, obsessive-compulsive disorder, depression, alcoholism and diabetes. Other more noticeable symptoms include obesity of the upper torso coupled with disproportionately thin limbs, a round and red face with characterized fullness, and acne or certain other skin infections. The less common symptoms include a buffalo hump, backache, tenderness and pain of the bones, rib and spine fractures, weak muscles, excessive hair growth in the woman, impotence and lack of sexual desire in men, and certain headache, tiredness and feelings of thirst and hunger (Nieman et al., 2008). Treatment The treatment of choice is surgical removal of the tumor. This should be followed by treatment with hydrocortisone or hydrocortisone replacement therapy because cortisol levels will go down fast once the tumor is removed. Moreover, in the case of patients with malignant adrenal cortical neoplasm, the treatment of choice must be open adrenalectomy (Thomson et al., 2010). Through an MRI scan, cases of mediastinal masses that intertwine with the heart nerves must be done with extreme care so as not to injure such a delicate organ. Moreover, CT-guided coaxial core biopsy to investigate whether it is really a carcinogenic mediastinal mass (McEvoy et al., 2011). Furthermore, non-steroidal or non-glucocorticoid drugs may be prescribed since glucocorticoids may boost cortisol levels again after surgery (Hopkins & Leinung, 2005). Chinese medicine may also be used for treatment. According to Flaws and Sionneau (2005), Cushing’s syndrome is all about problems with the qi or chi of the spleen and kidney due to aging, wrong diet or a chronic disease. One should therefore “enrich yin and subdue yang” using roots and rhizomes like Gou Teng and Niu Xi (Flaws & Sionneau, 2005). Acupuncture may also be used (Flaws & Sionneau, 2005). Linda Garnier (2003), a survivor of Cushing’s Syndrome, also gives some tips for prevention of Cushing’s Syndrome. First, one should be really aware of what he is eating and how much, because only nutritious and wholesome foods can prevent the disease. Second, one should try to exercise his brain, since Cushing’s syndrome usually causes problems with memory and cognition. The patient may use crossword puzzles or math problems, or objects that will improve memory, speed of thought and brain function. Third, the patient should try to increase his activities gradually until he finally overcomes the muscle weakness caused by the overproduction of ACTH in Cushing’s Syndrome (Garnier, 2003). Prevention Furthermore, according Linda Garnier (2003), the best diet that would prevent an occurrence or a recurrence of the disease is one that avoids weight gain, and one that should be eaten in six small portions in a day. It should be both low in calorie and fat. Healthy sources of protein include chicken without the skin and fish. Moreover, Garnier’s (2003) model outline of her diet consists of the following: a piece of fruit for breakfast; two whole grain crackers for late morning snack; a small serving of lean protein and a vegetable for lunch; fruit for mid afternoon snack; lean protein and vegetable for dinner; and fruit, frozen fruit pop or popcorn for evening snack. The most essential aspect of this prescribed diet is that all meals are eaten in small amounts (Garnier, 2003). Breakthroughs One recent breakthrough in the treatment of Cushing’s Syndrome is the use of nasal surgery where “the endoscope enters the skull base through the sphenoid sinus” and the pituitary tumor is removed (Patient’s Symptoms of Cushing’s Disease, 2007). This is practically a painless procedure and one that leaves no scars and is considered to be more accurate because of the greater visibility of the tumor through an endoscope and not through a microscope (Patient’s Symptoms of Cushing’s Disease, 2007). Moreover, the procedure eliminates any possibility of incisions, nerve damage in the mouth, and no swelling as the tumor is simply pulled out through the nose (Cushing’s Disease, 2010). References Blevins, L. S. Jr. (2002). Cushing’s Syndrome. Dordrecht, the Netherlands: Kluwer Academic Publishers Group, 55. Cushing’s Disease: Surgery Through the Nose. (2010). Retrieved from Ivanhoe.com: http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=23477 Flaws, B. & Sionneau, P. (2005). “Cushing’s Syndrome.” The Treatment of Modern Western Medical Diseases with Chinese Medicine. Boulder, CO: Blue Poppy Press, 213-218. Garnier, L. (2003). My Battle with Cushing’s Disease. Coral Springs, FL: Llumina Press, 60-61. Hopkins, R. L. & Leinung, M. C. (2005). “Exogenous Cushing’s Syndrome and Glucocorticoid Withdrawal.” Endocrinology and Metabolism Clinics of North America, 34, 371-384. Interview with Dr. Lewis Blevins: Pituitary Disorders. (2010). Retrieved from the University of California San Francisco: http://www.ucsfhealth.org/education/interview_blevins_pituitary_disorders/index.html McEvoy, M. P., Rich, B. S., New, M., Tang, L. H. & La Quaglia, M. P. (2010). “Thymic Carcinoid Presenting With Cushing’s Syndrome in a 17-Year-Old Boy: A Case Report and Review of Literature.” The Journal of Clinical Oncology, 29(25), 716-718. Nieman, L. K., Biller, B. M. K., Findling, J. W. & Newell-Price, J. (2008). “The Diagnosis of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guidelines.” Journal of Clinical Endocrinology and Metabolism, 93(5), 1526-1540. Patient’s Symptoms of Cushing’s Disease Beginning to Abate After Endoscopic Pituitary Cure. (2007). Retrieved from Medical News Today: http://www.medicalnewstoday.com/releases/90154.php Thomson, S., Koren, G., Fraser, L. A., Rieder, M., Friedman, T. C. & Van Uum, S. H. (2010). “Hair Analysis Provides a Historical Record of Cortisol Levels in Cushing’s Syndrome.” Endocrinology and Metabolism Clinics of North America, 118(2), 133-138. Read More