Overactive Adrenal Glands: Cushing’s Syndrome

The adrenal glands are like “top hats” on the kidneys, their job is to produce different kinds of steroid hormones, especially cortisol & adrenaline.

These hormones are necessary for life because they regulate stress responses that control blood pressure and how our cells use glucose.
Sometimes the adrenal glands can make too much of these hormones, and this has very important consequences on patients’ overall health.
The general term for excess cortisol is Cushing Syndrome.

Why would the adrenal gland become overactive?

Sometimes there is a tumor in the pituitary gland in the brain.
- This gland normally makes ACTH, which signals the adrenal glands to do their job.
- If that tumor happens to make ACTH independently, then the adrenal glands respond by pumping out a lot of cortisol.
Sometimes there is a nodule in the adrenal gland that makes cortisol independently.
Some types of cancer can make ACTH or cortisol independently.

What are the symptoms of Cushing Syndrome?

The classic “textbook” appearance is obesity, especially at the midsection, with red/purple stretch marks, excess hair, a “buffalo hump” and a “moon face.”
Patients may have fatigue, weakness, excessive bruising, high blood sugars and high blood pressures.

How do we diagnose Cushing Syndrome?

First we do a screening test
- Take 1-2mg of dexamethasone at 11:00pm and then have blood drawn at 8:00am the next day. A normal person will show a low cortisol (less than 1.8) in response to taking that dexamethasone.
If the screening test is positive, we have to confirm that result with 2 other tests.
- Salivary cortisol: taken at midnight on 3 consecutive nights.
- 24 hour urine collection to measure cortisol concentration.
If the lab tests confirm excess cortisol, we have to find the source.
- CAT scan adrenal glands
- Lab tests for ACTH
- If no source is easily found, we have to think about whether a cancer might be making the hormone.

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I have Cushing Syndrome, how do we treat it?

If the source is the pituitary gland, the first line definitive treatment is surgical removal of the tumor by a neurosurgeon.
If the source is an adrenal nodule, the first line definitive treatment is surgical removal of the tumor/gland by either a general surgeon or a urologist. The remaining gland can compensate hormonally.
If the patient is not a safe candidate for surgery, there are medications that can be given to block excess cortisol.

What happens after definitive treatment?

Patients will show an impressive change: they lose weight, diabetes resolves, blood pressure decreases and their healthspan & lifespan improves significantly.

Resources

Google image search “Cushing Syndrome Before and After Surgery”
Mayo Clinic www.mayoclinic.com section on Cushing Syndrome
NIH https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome