Cushing's syndrome

Cushing syndrome is a condition that occurs when the body has been constantly exposed to high levels of a certain type of hormone called cortisol. This can result to a wide array of symptoms including obesity in the truncal area, slow growth among children and acne. ^[1]  

Epidemiology

Estimates show that 10 to 15 million people are affected annually. ^[2]

Causes

The frequent cause is too much intake of corticosteroids. These drugs are often prescribed as anti-inflammatory agents and as treatment for autoimmune diseases.
Some people develop the condition as a consequence of excessive production of cortisol, a hormone generated by the adrenal gland. This may arise on cushing’s disease which is an illness characterized by too much cortisol production as a result of too much adrenocorticotropic hormone (ACTH) due to defects in the processes normally executed by the pituitary gland. Usually, a tumor in the pituitary gland is the main problem. Other causes of disproportionate cortisol include tumor of the adrenal gland or any part involved in ACTH production. Most of the cases are not hereditary. There is however a familial type which means the individual inherited the tendency to develop tumor on endocrine organs leading to Cushing syndrome. ^{[1] [2]}

Signs and Symptoms

Patients may complain of weight gain especially in the upper body, a round and full face or “moon face” and skin changes such as acne, purple stretch marks and easy bruising. Females may experience irregularities in menstruation, excess hair growth and decreased libido. Males may have impotence and decreased libido as well. Mental changes may include depression and problems with cognition. Some patients may have backache, weak muscles, bone pain and ‘buffalo hump’ or a hump behind the shoulders or neck.
Those with Cushing’s disease may have headache, abnormal excretion of milk from breasts and problems with vision. ^[3]

Diagnosis

After getting the patient’s medical history and performing a physical examination, the physician typically requests for laboratory exams to diagnose the condition. Among the tests include determining serum cortisol and ACTH level, 24-hour urine for cortisol and creatinine and dexamethasone suppression test.

Treatment

Treatment depends on the underlying cause. If the condition arises due to excessive use of corticosteroid, the drug dose is usually slowly decreased or tapered under medical supervision. Those caused by tumor may need medication or surgery. ^[3]

References:

1.      http://www.nlm.nih.gov/medlineplus/ency/article/000410.htm

2.      http://www.medicinenet.com/cushings_syndrome/article.htm

3.      http://emedicine.medscape.com/article/117365-clinical

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Neural Therapy:

Please note, this management does NOT treat the condition itself. It is proposed only as supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (there is insufficient evidence to show that Neural Therapy helps in treating Cushings Syndrome in any way)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org