“Treatments for Cushing’s is designed to lower the high level of cortisol in your body. The best treatment for you depends on the cause of the syndrome which determines if it is the disease versus the syndrome.”

MAYO CLINIC

CUSHING’sDISEASE.

What you can expect is your doctor will do a physical examine your entire body to look for specific physical signs of Cushing’s disease and may do tests to better understand your symptoms, what we call diagnostic tooling.

Confirm hypercortisolism
Medical tests will be performed to measure the level of cortisol in the body. These tests should only be done when a form of Cushing’s syndrome(including Cushing’s disease) is highly suspected.

-24 hour urinary free cortisol (UFC) –

Measures the level of cortisol in your urine over a 24-hour period. If the levels are too high, then you may have Cushing’s disease or Cushing’s syndrome. This test is often used because it only measures the type of cortisol that causes Cushing’s disease, called “circulating cortisol,” and may be more accurate than other tests that measure cortisol levels

Because of the difficulty in obtaining 24-hour urine collections in many outpatients, some physicians use a l-mg overnight dexamethasone suppression test. For this test, the patient takes l mg of dexamethasone orally at 11 p.m., and the plasma cortisol level is measured at 8 a.m. the following day (normal value: 5 μg per dL or less [140 nmol per L]). The reported sensitivity of this test is 98 percent; the reported specificity is 80 percent.

Obesity, chronic illness, chronic alcoholism and depression can cause false-positive results (pseudo-Cushing’s syndrome) on the 1-mg dexamethasone suppression test and mildly elevated free cortisol values on the 24-hour urine collection.

If the result of the dexamethasone suppression test is abnormal or the 24-hour urinary free cortisol level is mildly elevated, a confirmatory test for Cushing’s syndrome is needed. The 24-hour urine collection for urinary free cortisol excretion can be used to confirm the result of the l-mg dexamethasone suppression test. Normal findings on both tests provide strong evidence against the presence of Cushing’s syndrome.   However, when Cushing’s syndrome is still strongly suspected based on the clinical findings, negative tests should be repeated; the tests should also be performed again in three to six months.

Determine if Cushing’s disease is the cause of hypercortisolism

-Adrenocorticotropic Hormone (ACTH) test-

Measures if the amount of ACTH in your blood is higher than normal.

If your ACTH levels are high or normal, then you may have a tumor that is producing ACTH.

ACTH-producing tumors are most often found on the pituitary (Cushing’s disease).

ACTH-producing tumors may be in other areas of the body (called ectopic Cushing’s syndrome) If your ACTH levels are low, you may have Cushing’s syndrome due to a different cause or another condition. Additional tests will be done to confirm whether or not you have Cushing’s syndrome

Treatment of cushings syndrome is by castigation of the underlying cause.

Treatments for Cushing’s syndrome are contrived to pass your body’s cortisol production to normal. By indurate, or even distinctly lowering cortisol levels, you’ll feel evident improvements in your signs and symptoms. Left untreated, however, Cushing’s syndrome can finally induce to death. The treatment choice depend on the cause. For example:

-If a tumour in an adrenal gland is the reason, an operation to withdraw it will cure the condition.

– For adrenal hyperplasia, both adrenal glands may require to be withdraw. You will then require to take lifelong replacement therapy of several adrenal hormones.

-Other tumours in the body that produce ‘ectopic’ ACTH may be able to be removed, depending on the kind of tumour, where it is, etc.

-Medication to block the production or consequence of cortisol may be an choice.

“When too much cortisol is present in the body, it is called Cushing’s syndrome, regardless of the cause.  it is called Cushing’s syndrome, regardless of the cause. Cortisol is made by the adrenal glands which are stimulated by ACTH, which is produced in pituitary gland. When the cause of the excess cortisol is excess ACTH made by a pituitary tumor, the condition is called “Cushing’s disease. “

Harvard Medical School

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 syndrome appears when the body’s tissues are display to immoderate levels of cortisol for long periods of time.

There are two types of the disease and they are known as exogenous and endogenous. Exogenous Cushing syndrome is caused by something outside of the body, like when hormones are given to a patient during a RX for another condition. Endogenous is caused by natural causing problems within the body. Endogenous is likely to be hereditary and not caused by an outside force like a steroid complex.

 Causes of Cushing Syndrome

The most common cause of Cushing’s syndrome is exogenous administration of glucocorticoids prescribed by a health care practitioner to treat other diseases (called iatrogenic Cushing’s syndrome). This can be an effect of corticosteroid treatment of a variety of disorders such as asthma and rheumatoid arthritis, or in immunosuppression after an organ transplant.

Administration of synthetic ACTH(adrenocorticotropichormone) is also possible, but ACTH is less often prescribed due to cost and lesser utility. Although rare, Cushing’s syndrome can also be due to the use of medroxyprogesterone In this form of Cushing’s, the adrenal glands atrophy due to lack of stimulation by ACTH, since glucocorticoids downregulate production of ACTH. Cushing syndrome in childhood usually results from use of glucocorticoid medication^.

Endogenous Cushing’s syndrome results from some derangement of the body’s own system of secreting cortisol. Normally, ACTH is released from the pituitary gland when necessary to stimulate the release of cortisol from the adrenal glands.

In pituitary Cushing’s, a benign pituitary adenoma secretes ACTH. This is also known as Cushing’s disease and is responsible for 70% of endogenous Cushing’s syndrome.

In adrenal Cushing’s, excess cortisol is produced by adrenal gland tumors, hyperplastic adrenal glands, or adrenal glands with nodular adrenal hyperplasia.

Tumors outside the normal pituitary-adrenal system can produce ACTH (occasionally with CRH) that affects the adrenal glands. This etiology is called ectopic or paraneoplastic Cushing’s disease and is seen in diseases like small cell lung cancer.

Finally, rare cases of CRH-secreting tumors (without ACTH secretion) have been reported, which stimulates pituitary ACTH production.

Pseudo-Cushing’s syndrome

 Elevated levels of total cortisol can also be due to estrogen found in oral contraceptive pills that contain a mixture of estrogen and progesterone, leading to Pseudo-Cushing’s syndrome. Estrogen can cause an increase of cortisol-binding globulin and thereby cause the total cortisol level to be elevated. However, the total free cortisol, which is the active hormone in the body, as measured by a 24 hour urine collection for urinary free cortisol, is normal.

Epidemiology

 Iatrogenic Cushing’s syndrome (caused by treatment with corticosteroids) is the most common form of Cushing’s syndrome.

Symptoms of Cushings Syndrome

 Symptom of cushings syndrome include fat deposits close to the face neck and trunk; weariness; muscular weakness; salt and water retention; acne; leisurely bruising; menstlruall irregularities; and signs (in women) of virilisation, such as increase of the voice, commute in body, shape, loss of scalp hair, and extend in facial and body hair. Complications of cushings syndrome include advanced blood pressure, The symptoms and signs of cushings syndrome induced by a chronic redundant of corticosteroid hormones in the blood. The redundant may be acquired by a tumour of the outer part (cortex) of the adrenal gland, or may be referable to over inspiration of the adrenal glands by a tumour the pituitary gland.

Many children and teenagers with Cushing’s syndrome will exhibit various symptoms of the following:

-extreme weight gain

-growth retardation

-missed periods in teenage girls

-excess hair growth

-acne

-reddish-blue streaks on the skin

-high blood pressure

-tiredness and weakness

-either very early or late puberty

Adults with the disease may also have symptoms of intense weight gain, redundant hair growth, high blood pressure, and skin difficulties. In addition, they may show:

-muscle and bone weakness

-moodiness, irritability, or depression

-sleep disturbances

-high blood sugar

-menstrual disorders in women and diminished fertility in men

Complications include:

 -Diabetes (High or Low blood glucose levels)

-Enlargement of pituitary tumor and other complications from the tumor growth

-Fractures due to osteoporosis which are common in older people

-High blood pressure which could be life threatening

-Kidney stones from the increase in cortisol and other chemicals filtered through the kidneys

-Serious infections which could lead to further secondary infections

Tune in this weekend for how the disease is treated.

“The best course of action for occasional sinusitis is to use self-care steps to ease symptoms while the body clears the infection.  Everybody sort of thinks of antibiotics as the magic cure-all, but the vast majority of people will get better without ever having to consider an antibiotic.”

Dr. Jeffrey Linder, a PCP & associate professor of medicine at Harvard-affiliated Brigham & Women’s Hospital.

“Cardiac arrest may be caused by almost any known heart condition. Most cardiac arrests occur when the diseased heart’s electrical system malfunction; one common cause is due to potassium levels.”

American Heart Association

Potassium is a mineral that your body needs to work properly. It is a type of electrolyte. It helps your nerves to function and muscles to contract. It helps your engine of the body to operate properly , being the heart.  Potassium kept within the normal blood range helps keep the heartbeat stay regular. It also helps move nutrients into cells and waste products out of cells.  A diet rich in potassium helps to offset some of sodium’s harmful effects on blood pressure.   Knowing sodium’s impact on your blood pressure, a boost in your daily potassium intake can help you to maintain a healthy blood pressure or lower it to healthy levels.

Electrolytes are substances that help conduct electricity in your body. Potassium is one of the most important electrolytes in the human body, with others including chloride, calcium, phosphorus, magnesium and sodium. As an electrolyte, potassium is vital to the healthy functioning of all of your body’s cells, tissues and organs. It also helps to control the amount of water in your body and maintain a healthy blood pH level. As you lose electrolytes in your sweat, you should always obtain a source of these important minerals during or after a intense physical activity.

Potassium is particularly important for the ability of your skeletal and smooth muscles to contract. Because of this, an adequate intake of potassium is important for regular digestive and muscular functioning. Potassium is also vital to the health of your heart, as a normal heart rhythm arises from optimal muscular functioning. This is especially apparent if you have excessively high or low potassium levels, both of which can cause an irregular heartbeat. As heart arrhythmias are potentially life-threatening, you should always maintain an adequate daily intake of potassium.

When a M.D. or in the hospital the doctor orders electrolytes or drug levels to be done it is measuring the level outside the cell in our bloodstream.  Potassium (K⁺) is the most abundant cation (action) in the body. About 90% of total body potassium is intracellular and 10% is in extracellular fluid, of which less than 1% is composed of plasma. The ratio of intracellular to extracellular potassium determines neuromuscular and cardiovascular excitability, which is why serum potassium is normally regulated within a narrow range of 3.5 to 5.0 mmol/L since the abundance of the potassium is in the red blood cell and its impossible to measure blood levels of anything inside a cell since it would destroy the cell.

Ingested K⁺ is absorbed rapidly and enters the portal circulation, where it stimulates insulin secretion. Insulin increases Na⁺,K⁺-ATPase activity and facilitates potassium entry into cells, thereby averting hyperkalemia. β²-Adrenergic stimulation also promotes entry of K⁺ into cells through increased cyclic adenosine monophosphate (cAMP) activation of Na⁺,K⁺-ATPase.  Remember a person with diabetes has very little or no insulin at all which will effect potassium being sent into the cell unless the patient takes their insulin as ordered by the M.D.

Hypokalemia is serum potassium concentration < 3.5 mEq/L caused by a deficit in total body potassium stores or abnormal movement of potassium into cells. The most common causes are excess losses from the kidneys or GI tract. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. Diagnosis is by serum measurement. Treatment is giving potassium and managing the cause.

Low potassium (hypokalemia) has many causes. The most common cause is excessive potassium loss in urine due to prescription water or fluid pills (diuretics). Vomiting or diarrhea or both can result in excessive potassium loss from the digestive tract. Only rarely is low potassium caused by not getting enough potassium in your diet.

Hyperkalemia

If you have hyperkalemia, you have too much potassium in your blood. The body needs a delicate balance of potassium to help the heart and other muscles work properly. But too much potassium in your blood can lead to dangerous, and possibly deadly, changes in heart rhythm.

Hyperkalemia is a common diagnosis. Fortunately, most patients who are diagnosed have mild hyperkalemia (which is usually well tolerated). However, any condition causing even mild hyperkalemia should be treated to prevent progression into more severe hyperkalemia. Extremely high levels of potassium in the blood (severe hyperkalemia) can lead to cardiac arrest and death. When not recognized and treated properly, severe hyperkalemia results in a high mortality rate.

Technically, hyperkalemia means an abnormally elevated level of potassium in the blood. The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter (mEq/L). Potassium levels between 5.1 mEq/L to 6.0 mEq/L reflect mild hyperkalemia. Potassium levels of 6.1 mEq/L to 7.0 mEq/L are moderate hyperkalemia, and levels above 7 mEq/L are severe hyperkalemia.

Potassium is critical for the normal functioning of the muscles, heart, and nerves. It plays an important role in controlling activity of smooth muscle (such as the muscle found in the digestive tract) and skeletal muscle (muscles of the extremities and torso), as well as the muscles of the heart. It is also important for normal transmission of electrical signals throughout the nervous system within the body.

Normal blood levels of potassium are critical for maintaining normal heart electrical rhythm. Both low blood potassium levels (hypokalemia) and high blood potassium levels (hyperkalemia) can lead to abnormal heart rhythms.

The most important clinical effect of hyperkalemia is related to electrical rhythm of the heart. While mild hyperkalemia probably has a limited effect on the heart, moderate hyperkalemia can produce EKG changes (EKG is a reading of the electrical activity of the heart muscles), and severe hyperkalemia can cause suppression of electrical activity of the heart and can cause the heart to stop beating.

“A loved one’s suicide can be emotionally devastating. Use healthy coping strategies — such as seeking support — to begin the journey to healing and acceptance.”

MAYO CLINIC

“Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. It’s estimated for the number of colorectal cancer cases in the United States for 2017 are: 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer.  Colorectal cancer is the third leading cause of cancer-related deaths in women in the United States  and the second leading cause in men.”

American Cancer Society