Cushing's syndrome. Cushing's disease Cushing's disease forecast

Cushing's disease is a brain disorder in which the hypothalamus or pituitary gland produces excessive amounts of adrenocorticotropic hormone.

This hormone regulates the functioning of the adrenal glands.

With an excess of this important hormone, the adrenal glands also increase secretion, which leads to various diseases.

The hypothalamus is a section of the brain that is divided into three parts.

The middle lobe produces hormones that affect the functioning of the pituitary gland.

The hypothalamus regulates the following processes:

• sexual function;
• presence or absence of appetite;
• learning process;
• amount of urine;
• emotional state;
• blood supply;
• thermoregulation.

The pituitary gland is a small gland consisting of three parts. Each of them produces certain hormones that regulate the functioning of the thyroid gland and other organs.
There are three types of cells in the anterior lobe of the gland:

1. Basophils - produce adrenocorticotropic hormone.
2. Acidophilic - contained in thirty-five percent.
3. Chromophobic - they contain sixty percent.

1. Estrogens are responsible for the development of secondary sexual characteristics in women and stimulate the growth of the genital organs.
2. Androgens are responsible for libido and secondary sexual characteristics in both sexes.
3. Glucocorticoids– increase blood pressure, reduce calcium absorption, and promote excessive secretion of juice in the stomach.
4. Mineralocorticoids- retain water between cells.

That is, all these organs are interconnected and any failure in their work leads to serious disturbances in the health of the entire organism. A distinction is made between Cushing's disease and Cushing's syndrome.

Both disorders are similar in symptoms, but have different etiologies. Itsenko-Cushing syndrome manifests itself due to the overproduction of glucocorticoids, which occurs due to the use of hormones, and for a long time.

As for Itsenko-Cushing's disease (hypercortisolism), the lesion occurs in the pituitary system, and the endocrine glands are included in the pathogenesis later.

Interesting!

Both Itsenko-Cushing syndrome and hypercortisolism usually manifest in women twenty to forty years old.

Causes of Itsenko-Cushing's disease

Why does Itsenko-Cushing's disease occur? Most often, it is difficult to find the source of the disease.
However, experts identify several factors that can lead to this disease:

• skull injuries;
• brain infections;
• severe mental trauma;
• adenoma of the anterior pituitary gland;
• hormonal changes;
• poisoning of the body.

Any factor can contribute to the development of a pathological mechanism: disruption of the relationship between the hypothalamus, pituitary gland and adrenal glands.
The following phenomena occur:

• failure of fat metabolism;
• ovarian function is impaired;
• osteoporosis develops;
• arterial hypertension occurs.

As a result, the work of the adrenal glands is overly activated and the level of certain hormones that affect protein-carbohydrate metabolism increases.

Symptoms of Itsenko-Cushing's disease

How does this disorder manifest itself? Diagnosing the disease is not difficult, as the symptoms are quite clear. Moreover, they manifest themselves from different systems of the body.

This is observed in almost all patients, and fat is deposited on the chest, abdomen, neck and back, especially the upper part. In addition, the face becomes round.

Moreover, unlike other forms of obesity, with Itsenko-Cushing's disease the covering on the palms becomes transparent and very thin. Here is a photo of a patient with Cushing's disease.

External manifestations

The skin changes greatly during illness. It becomes too dry and flaky, acquiring a purple-marble color.

Usually form large streaks of red or purple, the stomach and hips suffer. The skin is very thin, so even the blood vessels are visible. And the vessels themselves are fragile, so the patient often develops long-healing bruises.

With this disorder, there is increased growth of body hair. In women, male-type hair appears on the chest and face.

Men have a lot of hair on their bodies, and bald spots form on their heads. To this are often added various skin lesions - ulcers, pustules, as the sebaceous and sweat glands become inflamed.

Internal manifestations

Bones and muscles also undergo changes, so bones are affected in 95% of cases with this disease.

Since calcium is poorly absorbed and proteins are destroyed, osteoporosis develops.
The shapes of body parts change:

• brushes;
• skulls;
• stop;
• spine.

This causes severe pain and frequent fractures. In children, growth is delayed, and in adults, it decreases by 10 centimeters or more. As proteins break down, muscles atrophy. Consequently, the limbs lose a lot of weight.

Itsenko-Cushing's disease is characterized by:

• decreased intelligence;
• memory impairment;
• the appearance of apathy or depression.

The patient may be too emotional or indifferent to everything. In addition, osteophytes put pressure on the nerve endings that are located next to the deteriorating bones. This leads to severe pain, which further aggravates the mental state.

If the disease lasts for a long time, the patient may experience suicidal thoughts and behavior.

Other signs and complications

Pathology leads to a number of complications. The disease causes a decrease in immunity. The body becomes sensitive to infections.
Most often, respiratory diseases develop against this background:

• pneumonia;
• bronchitis.

Regarding digestive system, heartburn and so-called steroid ulcers are usually observed. The liver may not function properly.

Hypertension

One of the most striking signs is increased blood pressure. It appears among the first symptoms. If measures are not taken in time, hypertension can cause problems with the cardiovascular system.

The heart will begin to beat less frequently, blood circulation will worsen, and all tissues and organs will lack oxygen. This could end in death.

Diabetes

Another common symptom is diabetes. Blood glucose levels rise due to the amount of glucocorticoids. This disrupts the metabolism of all substances in the body.

Therefore, we must keep in mind that an increase in blood glucose levels may be due to Itsenko-Cushing's disease.

But the course of this diabetes is mild and you can achieve a normal state with a diet and the use of drugs that reduce sugar.

Sexual dysfunctions

In 70% of cases it decreases sexual treatment both men and women. In addition, women usually stop menstruating and their organs become smaller.

It is almost impossible to get pregnant during the development of this disease, but if this does happen, the pregnancy ends in miscarriage. If the disease develops in a child, then sexual development stops.

Kidney diseases

There are several symptoms of the disease that relate to the urinary system. Pyelonephritis, an inflammation of the kidneys, may occur, and stones may also form in the bladder, as it is also excreted in the urine.

Moreover, constantly high blood pressure promotes kidney destruction. In its place, connective tissue forms and nephrosclerosis develops.

At the first signs of this disease, you should immediately contact a specialist for diagnosis and subsequent treatment.

The speed of developing pathology can vary - from six months to three to ten years. You should not wait until serious changes begin in your body.

You need to see a doctor as quickly as possible, otherwise the results of inaction can be disastrous.

Itsenko-Cushing's disease in children

This disorder occurs very rarely in children. Why does the disease appear at this age? This may be caused by improper use of certain medications or overactive adrenal glands.

Due to improper production of hormones, the functioning of many organs and systems is disrupted. IN early age the disease is the most dangerous.

For reference!

This disease occurs extremely rarely in children, but the incidence rate is slightly higher in adolescents.

The clinical manifestations of the disease are the same as in adults. That is, there may be a change in the condition of the skin. These are the most common signs.

In addition, in adolescence, a lag in sexual development will be clearly visible. We should not forget about disturbances in the emotional state.

The disease causes many complications. After all, childhood and adolescence are a time of growth and formation of the whole organism.
The consequences of this disease can be varied:

• bone problems;
• obesity;
• growth retardation;
• cessation or delay of puberty;
• skin problems;
• psychoemotional disorders.

As for treatment, it usually takes a long time. Both surgical methods and medications are used. Unfortunately, at this age various complications develop that affect future health.

However, at the same time, death at this age is a rarer occurrence than in adults, since the body is still young and fights better.

Diagnostics

In order to accurately make a diagnosis, the joint work of several specialists is required. It all depends on the symptoms; you may need a gynecologist or cardiologist, as well as other specialized specialists.

They decide together what tests and investigations are needed and later jointly prescribe the necessary treatment.

The following tests are required:

1. A large dexamethasone test is used to differentiate between an adrenal tumor and Cushing's syndrome.
2. a – find out the level of cortisol before and after taking a certain substance.
3. Determination of daily excretion of free cortisol is a urine test.
4. MRI – to obtain information about the presence of a pituitary adenoma.
5. Tomography of the adrenal glands (magnetic or computer) - to obtain information about the enlargement of this organ.
6. X-ray of the spine - helps determine if there are problems with the bones.
7. Blood biochemistry is necessary to detect the presence of diabetes mellitus.

Treatment may vary in each specific case. It all depends on the characteristics of a particular case, as well as on the patient’s condition, the presence associated violations, the causes of the disease.

In any case, the doctor chooses the most best option and the patient must follow all the doctor’s recommendations.

Treatment of Itsenko-Cushing's disease

Typically, radiation and surgery are used to treat this disease, but other ways to combat the disease are also possible.

Medication

Symptomatic drugs, dopamine angonites. Drug therapy is carried out at the initial stage of the disease, as an auxiliary method before surgery or if it cannot be performed.
Prescribed drugs that suppress increased production certain hormones:

• Reserpine;
• Parlodel;
• Ketoconazole.

It is possible to use other drugs. The specialist will definitely prescribe medications that help relieve painful symptoms.
These medications include the following types:

• antidepressants - for depression;
• sedatives - for irritability;
• medications to treat osteoporosis and bisphosphonates;
• potassium preparations;
• medications that lower blood pressure;
Nuance!

Trepanation is performed extremely rarely.

Ray

There are various methods of such therapy. As for radiation exposure, it is carried out if not. Implantation can be used radioactive isotopes to the pituitary gland.

Most often, with this treatment there is a significant improvement, which is expressed in weight loss and the return of the menstrual cycle.

In addition, muscle and bone damage is reduced. Combined method - radiation treatment and adrenalectomy are used.

These are fermented milk products and eggs. Fatty, fried and spicy foods should be excluded from the menu. This will help relieve the symptoms of the disease.

Whatever the cause of the disease, it is necessary to strictly adhere to the specialist’s prescriptions. If you ignore your doctor's recommendations, complications may occur, including death.

Moreover, Itsenko-Cushing's disease can develop rapidly (development does not always last several years or months).

Further prognosis and prevention of the disease

If treatment is started on time and there are no complications yet, then the prognosis is favorable. In young patients with a mild form of the disease, complete recovery is possible.

If the disease is advanced, there are many concomitant diseases, then even long-term treatment cannot completely eliminate changes in various systems. As a result, health problems remain.

Advanced forms of this disease usually end in death.

In addition, it is imperative to avoid physical and psychological overload. It is important to follow a diet, take a vitamin-mineral complex, and strengthen the immune system.

As for the prevention of this disease, only regular examination will help in order to start treatment on time. Of course, it is necessary to avoid skull injuries, as well as various infectious diseases.

Changes in the production of hormones by the adrenal glands result in a variety of health effects. With their excessive activity, puberty occurs faster. If disturbances affect the medulla of the glands, the person develops arterial hypertension. Decreased adrenal function can lead to the development of Addison's disease, or, as it is also called, bronze disease. It is characterized by: skin pigmentation, exhaustion, decreased blood pressure, low sugar levels. With bronze disease, the body's resistance decreases. Dysfunction appears endocrine system may also involve changes in the activity of the gonads. Hormone production increases, mainly due to the development of malignant tumors. When the functions of the gonads decrease, a disease such as eunuchoidism is diagnosed. This disease manifests itself in excessive growth of the limbs with their abnormal lengthening, the appearance of a tendency towards obesity, underdevelopment of the genital organs and the absence of some secondary sexual characteristics.

Cushing's syndrome is hypercortisolism caused by an increase in the blood levels of endogenous or exogenous glucocorticoids (GC).

More often, Cushing's syndrome is iatrogenic in nature. The predominant age for Cushing's syndrome caused by a pituitary or adrenal adenoma is 25-40 years, for ectopic production of adrenocorticotropic hormone (ACTH) due to lung cancer - old age. The disease is more common among women (5:1). In the United States, the incidence of Cushing's syndrome, caused by endogenous hyperproduction of HA, is 13 cases per 1 million people.

Endogenous GCs appear due to their hyperproduction by the adrenal cortex in the presence of:

• glucosteromes;
• hyperproduction of ACTH by the anterior pituitary gland (presence of adenoma; in this case they speak of Itsenko-Cushing’s disease);
• ACTH-secreting tumors of various organs (primarily the lungs, pancreas; in this case they speak of the syndrome of ectopic ACTH production).

Exogenous GCs cause iatrogenic Cushing's syndrome, which occurs much more often than spontaneous; usually develops in patients receiving GCs for a long time for various diseases (for example, rheumatological).

Symptoms of Cushing's syndrome

• Obesity, moon face, buffalo hump (fat pad in the neck).
• Increased blood pressure.
• Hirsutism (excessive male pattern hair growth in women).
• Striae (purple stretch marks on the skin of the chest, abdomen, thighs).
• Muscle weakness.
• Osteoporosis.
• Tendency to bruise.
• Purple blush on the cheeks.
• Oligomenorrhea (weakening of menstruation).
• Acne rashes.
• Depression.

Diagnosis of Cushing's syndrome

• Overnight dexamethasone suppression test: the patient takes 1 mg of dexamethasone at 11 pm, and the serum cortisol level is measured the next morning at 8 am.
• Determination of glucose level.
• General analysis blood.
• General urine analysis.
• Computed tomography abdominal organs: allows you to identify enlarged adrenal glands.
• X-ray of the skull: reveals macroadenomas of the pituitary gland (10% of cases), X-ray of the lumbar spine - osteoporosis.
• Computed tomography of the brain: can detect about 50% of pituitary adenomas.

Treatment of Cushing's syndrome

Treatment for Cushing's syndrome depends on the cause. Iatrogenic syndrome involves the gradual withdrawal of GCs (with their replacement, if necessary, with other immunosuppressants). For adrenal adenoma it is indicated surgical treatment: tumor resection. Adrenal carcinoma, ectopic ACTH secretion: if ineffective or impossible surgical treatment They are treated with drugs that block the production of steroids by the adrenal glands - Mitotane, Metyrapone. Radiation therapy is used when treatment - surgical or drug - is ineffective, usually in combination with them. Radiation therapy increases the effect of drug treatment.

Essential drugs

There are contraindications. Specialist consultation is required.

• Reserpine (sympatholytic agent). Dosage regimen: orally, at a dose of 1 mg/day. The course of treatment is 3-6 months.
• (dopaminomimetic, hypoprolactinemic agent). Dosage regimen: orally, during meals, at a dose of 5 mg/day. The course of treatment is 6-12 months.
• Elipten (inhibitor of corticosteroid synthesis). Dosage regimen: orally, at a dose of 250 mg 2-3 times a day.

• Consultation with an endocrinologist.
• Determination of cortisol levels in blood serum.
• Determination of free cortisol excretion in daily urine.
• Special instrumental methods studies (of the head, adrenal glands or chest cavity) are prescribed after a hypothesis about the cause of the syndrome, based on laboratory findings, has been formulated.

In endocrinology, a distinction is made between the disease and Itsenko-Cushing syndrome (primary hypercortisolism). Both diseases manifest themselves with a common symptom complex, but have different etiologies.

The basis of Itsenko-Cushing syndrome is the overproduction of glucocorticoids by hyperplastic tumors of the adrenal cortex (corticosteroma, glucosteroma, adenocarcinoma) or hypercortisolism caused by prolonged administration of exogenous glucocorticoid hormones. In some cases, with ectopic corticotropinomas arising from cells of the APUD system (lipid cell tumor of the ovary, lung cancer, pancreatic, intestinal, thymus, thyroid cancer, etc.), the so-called ectopic ACTH syndrome develops with similar clinical manifestations.

In Itsenko-Cushing's disease, the primary lesion is localized at the level of the hypothalamic-pituitary system, and the peripheral endocrine glands are involved in the pathogenesis of the disease secondary.

Itsenko-Cushing's disease develops in women 3-8 times more often than in men; Mostly women of childbearing age (25-40 years) are affected.

The course of Itsenko-Cushing's disease is characterized by severe neuroendocrine disorders: a disorder of carbohydrate and mineral metabolism, a symptom complex of neurological, cardiovascular, digestive, and renal disorders.

Causes of Itsenko-Cushing's disease

The development of Itsenko-Cushing's disease in most cases is associated with the presence of a basophilic or chromophobe pituitary adenoma that secretes adrenocorticotropic hormone. In cases of tumor damage to the pituitary gland, patients are diagnosed with microadenoma, macroadenoma, and adenocarcinoma.

In some cases, there is a connection between the onset of the disease and previous infectious lesions of the central nervous system (encephalitis, arachnoiditis, meningitis), traumatic brain injuries, and intoxications.

In women, Itsenko-Cushing's disease can develop against the background of hormonal changes caused by pregnancy, childbirth, and menopause.

The basis of the pathogenesis of Itsenko-Cushing's disease is a violation of the hypothalamic-pituitary-adrenal relationship. A decrease in the inhibitory effect of dopamine mediators on the secretion of CRH (corticotropic releasing hormone) leads to hyperproduction of ACTH (adrenocorticotropic hormone).

Increased ACTH synthesis causes a cascade of adrenal and extra-adrenal effects. In the adrenal glands, the synthesis of glucocorticoids, androgens, and, to a lesser extent, mineralocorticoids increases.

An increase in the level of glucocorticoids has a catabolic effect on protein-carbohydrate metabolism, which is accompanied by muscle atrophy and connective tissue, hyperglycemia, relative insulin deficiency and insulin resistance with subsequent development of steroid-induced diabetes mellitus. Impaired fat metabolism causes the development of obesity.

Increased mineralocorticoid activity in Itsenko-Cushing's disease activates the renin-angiotensin-aldosterone system, thereby promoting the development of hypokalemia and arterial hypertension.

The catabolic effect on bone tissue is accompanied by leaching and decreased calcium reabsorption in gastrointestinal tract and the development of osteoporosis.

The androgenic properties of steroids cause ovarian dysfunction.

The severity of Cushing's disease can be mild, moderate or severe. A mild degree of the disease is accompanied by moderately severe symptoms: menstrual function can be preserved, osteoporosis is sometimes absent.

With moderate severity of Itsenko-Cushing's disease, the symptoms are pronounced, but complications do not develop.

The severe form of the disease is characterized by the development of complications: muscle atrophy, hypokalemia, hypertensive kidney, severe mental disorders, etc.

Based on the speed of development of pathological changes, a progressive and torpid course of Itsenko-Cushing's disease is distinguished.

The progressive course is characterized by a rapid (within 6-12 months) increase in symptoms and complications of the disease; with a torpid course, pathological changes develop gradually over 3-10 years.

Symptoms of Itsenko-Cushing's disease

With Itsenko-Cushing's disease, disorders of fat metabolism, changes in the bone, neuromuscular, cardiovascular, respiratory, reproductive, digestive systems, and psyche develop.

Patients with Itsenko-Cushing's disease are distinguished by a Cushingoid appearance, caused by the deposition of adipose tissue in typical places: on the face, neck, shoulders, mammary glands, back, abdomen.

The face has a moon-shaped shape, a fatty “menopausal hump” is formed in the area of ​​the VII cervical vertebra, the volume increases chest and belly; while the limbs remain relatively thin. The skin becomes dry, flaky, with a pronounced purple-marble pattern, stretch marks in the area of ​​the mammary glands, shoulders, abdomen, and intradermal hemorrhages. Acne or boils often occur.

Endocrine disorders in women with Itsenko-Cushing's disease are expressed by menstrual irregularities, sometimes by amenorrhea. There is excess body hair (hirsutism), facial hair growth and scalp hair loss.

Men experience reduction and loss of hair on the face and body; decreased libido, impotence.

The onset of Itsenko-Cushing's disease in childhood can lead to delayed sexual development due to decreased secretion of gonadotropic hormones.

Changes in the skeletal system resulting from osteoporosis are manifested by pain, deformation and bone fractures, and in children - delayed growth and differentiation of the skeleton.

Cardiovascular disorders in Itsenko-Cushing's disease may include arterial hypertension, tachycardia, electrolyte-steroid cardiopathy, and the development of chronic heart failure.

Patients with Cushing's disease are susceptible to frequent bronchitis, pneumonia, and tuberculosis.

Damage to the digestive system is accompanied by the appearance of heartburn, epigastric pain, the development of chronic hyperacid gastritis, steroid diabetes, “steroid” gastric and duodenal ulcers, and gastrointestinal bleeding. Due to damage to the kidneys and urinary tract, chronic pyelonephritis may occur, urolithiasis, nephrosclerosis, renal failure up to uremia.

Neurological disorders in Itsenko-Cushing's disease can be expressed in the development of pain, amyotrophic, brainstem-cerebellar and pyramidal syndromes.

If pain and amyotrophic syndromes are potentially reversible under the influence of adequate therapy for Itsenko-Cushing's disease, then the brainstem-cerebellar and pyramidal syndromes are irreversible. With brainstem-cerebellar syndrome, ataxia, nystagmus, and pathological reflexes develop.

Pyramidal syndrome is characterized by tendon hyperreflexia, central damage to the facial and hypoglossal nerves with corresponding symptoms.

In Itsenko-Cushing's disease, mental disorders such as neurasthenic, asthenoadynamic, epileptiform, depressive, and hypochondriacal syndromes may occur. Characterized by a decrease in memory and intelligence, lethargy, a decrease in the magnitude of emotional fluctuations; patients may experience obsessive suicidal thoughts.

The development of diagnostic and therapeutic tactics for Itsenko-Cushing's disease requires close cooperation between an endocrinologist, neurologist, cardiologist, gastroenterologist, urologist, and gynecologist.

In Itsenko-Cushing's disease, typical changes in biochemical blood parameters are observed: hypercholesterolemia, hyperglobulinemia, hyperchloremia, hypernatremia, hypokalemia, hypophosphatemia, hypoalbuminemia, decreased alkaline phosphatase activity.

With the development of steroid-induced diabetes mellitus, glucosuria and hyperglycemia are recorded.

A study of blood hormones reveals an increase in the level of cortisol, ACTH, renin; red blood cells, protein, granular and hyaline casts are found in the urine, and the secretion of 17-KS, 17-OX, and cortisol increases.

For the purpose of differential diagnosis of the disease and Itsenko-Cushing syndrome, diagnostic tests with dexamethasone and metopyrone (Liddle test) are performed.

An increase in urinary 17-OX excretion after taking metopyrone or a decrease in 17-OX excretion by more than 50% after dexamethasone administration indicates Cushing's disease, while the absence of changes in 17-OX excretion indicates Cushing's syndrome.

X-rays of the skull (sella turcica) reveal pituitary macroadenomas; with CT and MRI of the brain with the introduction of contrast - microadenoma (in 50-75% of cases). X-rays of the spine reveal pronounced signs of osteoporosis.

Examination of the adrenal glands (ultrasound of the adrenal glands, MRI of the adrenal glands, CT scan, scintigraphy) in Itsenko-Cushing's disease reveals bilateral adrenal hyperplasia.

At the same time, asymmetrical unilateral enlargement of the adrenal gland indicates glucosteroma.

Differential diagnosis of Itsenko-Cushing's disease is carried out with a similar syndrome, hypothalamic syndrome of puberty, and obesity.

Treatment of Itsenko-Cushing's disease

In Itsenko-Cushing's disease, it is necessary to eliminate hypothalamic changes, normalize the secretion of ACTH and corticosteroids, and restore impaired metabolism.

To treat the disease, drug therapy, gamma and x-ray therapy, proton therapy of the hypothalamic-pituitary region, surgical treatment, and a combination of various methods can be used.

Drug therapy is used in the initial stages of Cushing's disease. To block the function of the pituitary gland, reserpine and bromocriptine are prescribed.

In addition to centrally acting drugs that suppress ACTH secretion, blockers of the synthesis of steroid hormones in the adrenal glands can be used in the treatment of Cushing's disease.

Conducted symptomatic therapy, aimed at correcting protein, mineral, carbohydrate, and electrolyte metabolism.

Gamma, X-ray and proton therapy are usually performed in patients who have no radiological evidence of a pituitary tumor.

One of the methods radiation therapy is stereotactic implantation of radioactive isotopes into the pituitary gland.

Typically, a few months after radiation therapy, clinical remission occurs, which is accompanied by a decrease in body weight, blood pressure, normalization of the menstrual cycle, a decrease in bone and muscular systems. Irradiation of the pituitary gland can be combined with unilateral adrenalectomy or targeted destruction of the hyperplastic substance of the adrenal gland.

In severe forms of Cushing's disease, bilateral removal of the adrenal glands (bilateral adrenalectomy) may be indicated, subsequently requiring lifelong replacement therapy with glucocorticoids and mineralocorticoids.

If a pituitary adenoma is detected, endoscopic transnasal or transcranial tumor removal and transsphenoidal cryodestruction are performed.

After adenomectomy, remission occurs in 70-80% of cases; in approximately 20%, recurrence of the pituitary tumor may occur.

Forecast and prevention of Itsenko-Cushing's disease

The prognosis of Itsenko-Cushing's disease is determined by the duration, severity of the disease, and the age of the patient. At early treatment and mild forms of the disease in young patients, complete recovery is possible.

The long course of Itsenko-Cushing's disease, even when the root cause is eliminated, leads to persistent changes in the bone, cardiovascular, and urinary systems, which impairs the ability to work and aggravates the prognosis.

Advanced forms of Itsenko-Cushing's disease end in death due to the addition of septic complications and renal failure.

Patients with Itsenko-Cushing's disease should be observed by an endocrinologist, cardiologist, neurologist, gynecologist-endocrinologist; Avoid excessive physical and psycho-emotional stress, night shift work. Prevention of the development of Itsenko-Cushing's disease comes down to general preventive measures - prevention of head injury, intoxication, neuroinfections, etc.

Source: http://www.krasotaimedicina.ru/diseases/zabolevanija_endocrinology/itsenko-cushing

Cushing's syndrome: symptoms and treatment

Itsenko-Cushing syndrome is a pathological process, the formation of which is influenced by high levels of glucocorticoid hormones. The main one is cortisol. Therapy for the disease should be comprehensive and aimed at stopping the cause that contributes to the development of the disease.

What causes the disease?

Cushing's syndrome can occur due to various reasons. The disease is divided into three types: exogenous, endogenous and pseudosyndrome. Each of them has its own reasons for its formation:

1. Exogenous. Reasons for its development include overdose or prolonged use of steroids during treatment for another disease. As a rule, steroids are used when it is necessary to cure asthma and rheumatoid arthritis.
2. Endogenous. Its formation causes an internal malfunction in the body.
3. Pseudo-syndrome. There are times when a person experiences symptoms similar to those of Cushing's syndrome, but in reality this is not the case. This condition occurs due to excess weight, alcohol intoxication in chronic form, pregnancy, stress, depression.

How does the disease manifest itself?

Symptoms of Itsenko-Cushing syndrome

Cushing's syndrome manifests itself differently in each patient. The reason is that the body a certain person reacts in its own way to this pathological process. The following are the most common symptoms:

• weight gain;
• weakness, fatigue;
• excessive hair growth;
• osteoporosis.

Weight gain

Very often, the symptoms of Cushing's disease manifest themselves in rapid weight gain. This prognosis is observed in 90% of patients. In this case, fatty layers are deposited on the stomach, face, and neck. Arms and legs, on the contrary, become thin.

Muscle atrophy is noticeable in the shoulders and legs. This process causes symptoms in the patient associated with general weakness and fatigue.

In combination with obesity, this manifestation of the disease causes significant difficulties for the patient during exercise.

In certain situations, a person may experience pain if he stands up or squats.

Thinning skin

A similar symptom with Cushing's syndrome occurs quite often. The skin acquires a marbled tint, excessive dryness and has areas of local hyperhidrosis. The patient has cyanosis, and cuts and wounds take a very long time to heal.

Excessive hair formation

Such symptoms often occur in a woman who is diagnosed with Cushing's disease. Hairs begin to form on the chest, upper lip and chin.

The reason for this condition is the accelerated production of male hormones – androgens – by the adrenal glands.

In addition to this symptom, women experience menstrual irregularities, and men experience impotence and decreased libido.

Osteoporosis

Osteoporosis

This pathology is diagnosed in 90% of cases in patients with Cushing's syndrome. Osteoporosis manifests itself as a pain syndrome that affects bones and joints.

The formation of spontaneous fractures of ribs and limbs is possible.

If Itsenko-Cushing's disease affects a child's body, then there is a noticeable lag in the child's growth development.

Cardiomyopathy

With Cushing's syndrome, this condition affects the patient very often. Cardiomyopathy usually occurs mixed type. Its formation is affected by arterial hypertension, electrolyte imbalances or the catabolic effects of steroids. A person experiences the following symptoms:

In addition to the symptoms presented, Cushing's syndrome can cause pathologies such as diabetes. It is determined in 10–20% of cases. You can regulate blood sugar levels with the help of special medications.

Relatively nervous system the following manifestations occur:

• lethargy;
• depression;
• euphoria;
• poor sleep;
• steroid psychosis.

Development of the disease in children

Itsenko-Cushing's disease is diagnosed in young patients very rarely. But the severity of the course occupies a leading position among endocrine pathologies. The disease most often affects older children. But we cannot exclude the formation of the process in children preschool age.

The pathological process so quickly covers many types of metabolism, so timely diagnosis and therapy must be carried out as soon as possible.

The first sign of the disease in children is obesity. Fat is deposited in the upper torso. The face becomes moon-shaped and the skin color becomes purplish-red. In patients of preschool age, a uniform distribution of subcutaneous fat is observed.

90% of patients are diagnosed with growth retardation. Combined with excess weight, this leads to dehydration. Stunting is characterized by closure of the epiphyseal growth plates.

Children, like adults, begin to grow hair, although true puberty is delayed.

In boys, such symptoms are associated with a delay in the development of the testicles and penis, and in girls - in impaired ovarian function, uterine hypoplasia, lack of swelling of the mammary glands and menstruation.

Hair growth begins to affect areas of the body such as the back, spine, and limbs.

A characteristic manifestation of Cushing's syndrome is a violation of the trophism of the skin. This symptom is expressed in the formation of stretch bands.

They are usually concentrated on the lower abdomen, sides, buttocks, and inner thighs. These strips can be presented as singular, and in the plural. Their color is pink and purple.

During this process, the skin becomes dry, thin, and very easily injured. Often the child’s body is affected by ulcers, fungi, and furunculosis. The chest, face and back areas have acne.

Lichen-like rashes form on the skin of the torso and limbs. Acrocyanosis occurs. The skin on the buttocks area is dry and cold to the touch.

Itsenko-Cushing syndrome in children

Itsenko-Cushing's disease most often manifests itself in children in the form of osteoporosis of the bone skeleton. As a result, there is a decrease in bone mass. They become fragile, so fractures often occur.

The lesion is applied to the flat bone and tubular bone. When a fracture occurs, its own clinical features are noted: absence or sharp decrease pain syndrome at the fracture site.

During healing, a fairly large and long-lasting callus may form.

Itsenko-Cushing syndrome causes pathological changes relatively cardiovascular system in children. This manifests itself in the form of hypertension, electrolyte imbalance and hormonal imbalance.

Elevated blood pressure readings in this case are mandatory. This is a persistent and early symptom of the disease. Pressure readings depend on the patient's age. The younger he is, the higher his blood pressure will be.

Tachycardia is diagnosed in almost all patients.

Young patients experience neurological and mental disorders. These symptoms are characterized by the following features:

• multifocality;
• abrasion;
• different expression;
• dynamism.

Mental disorders often occur. This condition manifests itself in a depressive mood, agitation, and patients often experience suicidal thoughts. When Cushing's syndrome has achieved stable remission, all these manifestations quickly go away.

Children are often diagnosed with signs of steroid diabetes, which occurs without acidosis.

Therapeutic measures

Treatment of the disease first of all includes measures the purpose of which is to eliminate the cause of the pathology and balance the hormonal levels. Itsenko-Cushing syndrome may involve three treatment options:

• medicinal;
• ray;
• surgical.

Treatment methods for Itsenko-Cushing's disease

It is very important to start treatment on time, since according to statistics, if therapy is not started in the first 5 years from the start, then death occurs in 30–50% of cases.

Drug therapy

This treatment combines a complex of drugs whose action is aimed at reducing the production of hormones in the adrenal cortex.

Often, the doctor prescribes medications to the patient in combination with other treatment methods.

For the treatment of Itsenko-Cushing syndrome, the patient may be prescribed the following drugs:

• Mitotane;
• Metyrapone;
• Trilostane;
• Aminoglutethimide.

As a rule, these medications should be used when surgical treatment has not given a positive result, or the operation is simply impossible to perform.

Radiation therapy

Radiation therapy

It is advisable to use this method of treatment in cases where the disease was caused by a pituitary adenoma. Radiation therapy, due to its effect on the pituitary gland, can reduce the production of adrenocorticotropic hormone.

As a rule, this method of therapy is carried out in combination with drug or surgical treatment.

Often, it is due to the combination with medications that the enhanced effect of radiation therapy on the treatment of Cushing's syndrome occurs.

Surgical intervention

Surgery is often prescribed to treat the disease. It involves removing the adenoma using microsurgical techniques. The patient gets better very quickly, and the effectiveness of such therapy is 70–80%.

If Cushing's syndrome was caused by a tumor of the adrenal cortex, then surgery includes measures to remove this tumor.

If the disease is very severe, doctors remove two adrenal glands, as a result of which the patient will have to use glucocorticoids as replacement therapy throughout his life.

Cushing's disease is a condition characterized by increased production of glucocorticoid hormones by the adrenal glands.

The main manifestations of the disease are obesity and high blood pressure.

Treatment gives positive results only if all therapeutic procedures were performed in a timely manner.

Diseases with similar symptoms:

Hyperandrogenism (overlapping symptoms: 6 out of 20)

Hyperandrogenism is a pathological condition that occurs in girls and women and is characterized by increased level androgens in the body.

Androgen is considered male hormone– it is also present in the female body, but in small quantities, therefore, when its level increases, the woman develops characteristic symptoms, including cessation of menstruation and infertility, male pattern hair growth and some others. Changes in hormonal levels require urgent correction, as this can cause the development of many pathologies in a woman’s body.

...Obesity (overlapping symptoms: 5 out of 20)

Obesity is a condition of the body in which excess fat deposits begin to accumulate in its fiber, tissues and organs.

Obesity, the symptoms of which are weight gain of 20% or more when compared with average values, is not only a cause of general discomfort.

It also leads to the appearance of psycho-physical problems against this background, problems with the joints and spine, problems associated with sexual life, as well as problems associated with the development of other conditions accompanying such changes in the body.

...Myocarditis (matching symptoms: 5 out of 20)

Myocarditis is the general name for inflammatory processes in the heart muscle, or myocardium. The disease can appear against the background of various infections and autoimmune lesions, exposure to toxins or allergens.

A distinction is made between primary myocardial inflammation, which develops as an independent disease, and secondary, when cardiac pathology is one of the main manifestations of a systemic disease.

With timely diagnosis and complex treatment myocarditis and its causes, the prognosis for recovery is the most successful.

...Perimenopause (overlapping symptoms: 5 out of 20)

Premenopause is a special period in a woman’s life, the duration of which is individual for each female representative. This is a kind of gap between weakened and fuzzy menstrual cycle and the last menstruation that occurs during menopause.

...Myotonia (matching symptoms: 5 out of 20)

Myotonia is a genetically determined pathology that belongs to the category of neuromuscular diseases. It is noteworthy that, depending on its variety, it can manifest itself in at different ages, and not from the moment the baby is born.

The main reason for the development of the disease is the transmission of a mutating gene to a child from one or both parents, while they can be completely healthy. Other prerequisites influencing the development of such a rare disease remain unknown.

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Source: http://SimptoMer.ru/bolezni/endokrinnaya-sistema/561-sindrom-kushinga-simptomy

Itsenko-Cushing syndrome - causes and symptoms, diagnosis and treatment of the disease in children and adults

If, according to the results of the tests, there is an excess of glucocorticoid hormones in the adrenal glands, this is a sign of a dangerous disease.

Cushing's disease most often predominates in women and can be treated with conservative and surgical methods.

The patient experiences pronounced symptoms and needs timely diagnosis.

Causes of Itsenko-Cushing syndrome

For some patients, the diagnosis comes as an unpleasant surprise. In such cases, hormonal imbalance is preceded by the drug administration of synthetic hormones to successfully treat autoimmune conditions of the body.

We are talking about various medicines, for example, Prednisolone, Solu-Medrol, Dexamethasone for subcutaneous administration into the systemic circulation.

However, other causes of Itsenko-Cushing syndrome are also known, which in practice are acquired in nature and are considered pathological.

These were exogenous reasons why Cushing's syndrome appears, however, the characteristic ailment has another classification according to the etiology of the pathological process. So:

1. Pseudo-syndrome. This abnormal condition is only similar to Itsenko-Cushing's disease, but in reality, hormonal imbalance and ACTH concentration are preceded by overweight, congenital or acquired diabetes mellitus, chronic alcoholism, progressive pregnancy, a state of deep depression, impaired metabolism.
2. Endogenous factor. In this case, there really are health problems, and significant ones at that. This is a tumor of the pituitary gland, neoplasm reproductive system women, lung cancer, tumor processes of the adrenal cortex, for example, adenoma. Itsenko-Cushing's disease urgently needs an integrated approach; surgical intervention is not excluded.

Dysfunction of the pituitary gland and hypothalamus initially goes unnoticed by clinical patients. People learn about the diagnosis from a biochemical blood test, and quite by accident.

Symptoms of Itsenko-Cushing syndrome appear later and cause some concern for one’s own health. For example, the patient is concerned about the increase in body hair and the appearance of a hump on the neck.

In addition, for clinical picture The syndrome is characterized by the following changes in general well-being:

• increased fatigue;
• muscle weakness in Itsenko-Cushing's disease;
• relaxation and decrease in smooth muscle tone;
• rapid weight gain;
• moon-shaped face (matronism);
• osteoporosis with hypercortisolism;
• marble shade of the dermis with the appearance of a vascular pattern;
• decreased activity of the nervous system: obvious lethargy, passivity, absent-mindedness;
• increased signs of arterial hypertension (sudden surges in pressure);
• frog belly with the appearance of stretch marks;
• fat deposition in the cervical vertebrae;
• sweating disorder (increased sebum production);
• functional disorder of systemic digestion.

Itsenko-Cushing syndrome - diagnosis

To promptly identify hypercortisolism syndrome, you need to go through a series of laboratory research. Among them, a blood test is required to detect cortisol levels over several days.

In addition, when performing the same analysis, 17-hydroxycorticosteroids are assessed and ACTH levels are studied. The second prerequisite for Itsenko-Cushing's disease is to study the composition of urine. This is a general analysis.

In this way, Itsenko-Cushing syndrome can be determined; diagnosis also includes other measures:

• MRI of the pituitary gland, adrenal glands;
• fluoroscopy;
• CT scan of the sternum;
• radioisotope research;
• performing a series of Itsenko-Cushing tests.

Itsenko-Cushing syndrome in children

Hyperfunction of the adrenal glands can develop in childhood. Electrolyte disorders have a genetic predisposition, but in practice they are extremely rare.

The pathogenesis of this syndrome is studied individually, and the main symptoms are hypertension and dysplastic obesity.

It is possible that diabetes mellitus develops in a child’s body.

In order to finally cure Itsenko-Cushing syndrome in children, it is important to normalize hormonal levels and eliminate dysfunction of the patient’s adrenal cortex.

To get rid of the pathology and suppress its development, the attending physician strongly recommends using conservative and surgical methods strictly for medical reasons.

Peculiarities intensive care have the following form:

1. Taking steroid hormones in combination with gamma therapy.
2. Transsphenoidal adenomectomy or adrenalectomy.

Itsenko-Cushing syndrome - treatment

Hyperadrenocorticism requires correct diagnosis and timely prescribed therapy using predominantly conservative methods. Cushingoid requires dietary changes, mandatory medication, and physical therapy.

Treatment for Cushing's syndrome involves taking synthetic hormones to correct the Cushingoid (moon-shaped) face over time.

Additionally, it is necessary to take antidepressants, hypertensive drugs and representatives of other pharmacological groups, depending on the symptoms.

A complex operation for hypercortisolism involves removal of a tumor or other source of pathology.

Before surgical intervention, drug preparation is necessary.

This is necessarily insulin for diabetes, calcium and potassium preparations, anabolic steroids. Afterwards, surgery is performed on a patient with a moon-shaped face.

Cushing's disease and syndrome

With hypercortisolism, an increase in the level of cortisol in the blood is observed. However, the disease and syndrome have different etiologies of the pathological process.

For example, in case of illness these are obvious pathologies of the hypothalamic-pituitary system, and in case of syndrome we are talking about third-party external and internal stimuli. The main task of specialists is to correctly differentiate a progressive disease.

Only in this case, Itsenko-Cushing syndrome or disease can be quickly cured, hormonal levels stabilized, and dangerous health complications prevented.