Hypercortisolism, the symptoms and causes of which will be discussed in the article, is a disease characterized by long-term chronic exposure of the body to the hormones of the adrenal cortex in an abnormal, excessive amount. This pathology is also called Itsenko-Cushing's syndrome. And now it will be told in detail.
Reasons
Before considering the symptoms of hypercortisolism, we must briefly talk about the pathology itself. There are only two reasons why it can occur:
- Long-term treatment with glucocorticoids.
- Increased secretion of cortisol by the adrenal cortex.
In simpler terms, the cause is always a hormonal imbalance. Cortisol itself, synthesized by the pituitary gland, is vital for the body, because it is a regulator of carbohydrate metabolism, as well as a direct participant in the development of stress reactions.
In some people, due to their profession, the level of this hormone is constantly elevated. Athletes usually suffer from this. Cortisol is also actively produced in the bodies of women who are carrying a fetus. In pregnant women, the level of this hormone in the last months of the term increases significantly.
Also cortisol is produced in large quantities by alcoholics, heavy smokers and drug addicts. Also at risk are people suffering from any mental disorders.
Predisposing factors
Symptoms of hypercortisolism can be expected in one of the following circumstances:
- The presence of a hereditary predisposition (problems with the endocrine system that relatives had).
- Passing a long therapeutic course, which involved taking glucocorticoid hormones. The risk is especially high when using dexamethasone and prednisone.
- The presence of inflammatory processes or tumor formations occurring in the pituitary gland. It is important to make a reservation that this predisposing factor is more characteristic of the female body.
- Thyroid or lung cancer.
- Adenomas of the adrenal glands (benign tumors).
Classification
She should be given a little attention before talking about the symptoms and diagnosis of hypercortisolism. This pathology is of three types:
- Endogenous. The disease occurs due to internal disorders occurring in the body. In about 70% of cases, the cause is Itsenko-Cushing's disease. This is not a syndrome of the same name. The names are similar, but the pathologies themselves are not similar. Itsenko-Cushing's diseasecharacterized by increased production of adrenocorticotropic hormone by the pituitary gland. By the way, it stimulates the release of cortisol from the adrenal glands.
- Exogenous. Symptoms characterized by Cushingoid syndrome are most characteristic of this type of hypercortisolism. This is the most common type of pathology. The reason for the formation is long-term treatment with steroids. Glucocorticoids are commonly used to treat rheumatoid arthritis, asthma, or immunosuppression.
- Pseudo-syndrome. Sometimes, according to certain symptoms and manifestations, it seems that a person suffers from hypercortisolism. This can even be indicated by the results of a general diagnosis (which is why it is also important to conduct a differentiated one). It is by no means always specific symptoms that indicate that the patient has true hypercortisolism. And common causes of the development of pseudosyndrome are obesity, pregnancy, alcohol intoxication, depression and stress. Less often - in taking oral contraceptives containing progesterone and estrogens. Even a baby can experience a pseudo-syndrome, since substances present in the mother's body and causing this ailment enter his body along with mother's milk.
Be that as it may, the diagnosis will need to pass, and the treatment will be prescribed. But what exactly - this will be decided by the endocrinologist, taking into account the results of the examination and the specifics of the patient's body.
Signs of pathology
Now you should pay attention to the symptoms of hypercortisolism. MostThe hallmark is obesity. It is observed in more than 90% of patients with this diagnosis. Moreover, fat deposits are very uneven. They are localized on the back, abdomen, chest, neck, face. Limbs may be relatively thin.
Another symptom of hypercortisolism observed in men and women is a moon-shaped red-purple face with a cyanotic hue. This is also called "matronism". In addition to such a sign, a "climacteric" hump is also noticed. It occurs due to the deposition of fat in the region of the VII cervical vertebra.
There are changes in the structure of the skin. It thins out, becomes almost transparent. This is especially noticeable on the back of the hands.
Disorders in the muscular system
Continuing to study the symptoms of hypercortisolism (Itsenko-Cushing's syndrome), we must also make a reservation that with this disease, the tone and strength of the muscles decrease, and the muscles atrophy. All of these changes show signs of myopathy.
Also, patients have "sloping buttocks". What is it? This is the name of the syndrome, in which the volume of the gluteal and femoral muscles decreases. There is also a "frog belly", manifested by malnutrition.
Often a hernia of the white line of the abdomen is formed. The preperitoneal tissue and the hernial sac simply "protrude" through the slit-like spaces of the aponeurosis. This pathology is manifested by abdominal pain, flatulence, constipation, vomiting and nausea. However, its development can be recognized by the presence of a tumor-like protrusion: it can be seen with the naked eye.
Skin changes
Continuing the story about the causes and symptoms of hypercortisolism, it should be noted that the covers of people suffering from this disease have a characteristic "marble" hue. A vascular pattern is obvious on the skin, it itself is prone to dryness and flaking, in some places interspersed with separate areas of sweating.
If you pay attention to the skin of the thighs, buttocks, abdomen, mammary glands and shoulder girdle, you can notice stretch marks. These are striae of cyanotic or purple color, the length of which starts from a couple of millimeters and sometimes reaches 8 cm. Their width is frightening: stretch marks can reach 2 cm.
Patients also suffer from acne, spider veins, subcutaneous hemorrhage, and hyperpigmentation in some areas.
Bone problems
Their appearance is also a symptom of hypercortisolism in women and men. In the presence of this disease, the bone tissue is damaged and thinner, which leads to the development of osteoporosis. Its signs are severe pain, bone deformity (fractures are possible), scoliosis and kyphoscoliosis. The thoracic and lumbar regions are particularly affected.
Because of the compression of the vertebrae, people seem to lose height, gain stoop. If Itsenko-Cushing's syndrome is diagnosed in a child, then he lags behind in physical development. The reason is a slowdown in the development of epiphyseal cartilage.
Other changes
In addition to the above signs, there are many moresymptoms of hypercortisolism, which are also the consequences of this disease.
On the part of the heart, for example, cardiomyopathy often occurs, accompanied by manifestations of insufficiency and arterial hypertension. Many patients begin to suffer from extrasystole and atrial fibrillation.
The nervous system also suffers greatly. This is expressed in depression, lethargy, steroid psychosis. Some patients experience euphoria, others suicidal attempts.
Another 10-20% of people suffering from hypercortisolism develop the so-called steroid diabetes mellitus, which is in no way associated with pancreatic disease. The disease is relatively mild and can be quickly corrected by taking sugar-lowering drugs and following an individual diet.
Considering the symptoms of hypercortisolism in men and women, it should also be noted that often this disease causes the development of poly- and nocturia and edema (peripheral).
Manifestations of the disease depending on gender
Signs of this disease are the same in all patients. However, in addition to all of the above, men and women are faced with purely individual changes in their bodies. This is logical, because the hormonal background is gender specific.
Women with this pathology often experience infertility, amenorrhea, hypertrichosis, hirsutism and virilization. The menstrual cycle is also disrupted.
And men have obvious signs of feminization. Testicles may atrophy, libido and potency often decrease,gynecomastia.
Diagnosis
Much has been said above about the symptoms of hypercortisolism in men and women. Treatment will be discussed later, but now a little attention should be paid to the issue of diagnosis.
The basis for the suspicion of the considered pathology are physical and amnestic data. As part of the diagnosis, the first step is to determine the cause of hypercortisolism. For this purpose, screening tests are carried out. Namely:
- Examination of daily urine for the presence of cortisol excretion. If the level is 3-4 times higher than normal, then hypercortisolism is diagnosed.
- Small dexamethasone test. If a person is he althy, then taking this remedy will reduce the level of the hormone by at least two times. This does not happen with hypercortisolism.
There is also an increased content of 11-OX in the urine and a low level of 17-CS. There is hypokalemia, increased cholesterol and red blood cells.
In order to determine what exactly became the source of the pathology, CT or MRI is performed, as well as scintigraphy of the adrenal glands. If the doctor considers it necessary, he prescribes a biochemical blood test. Typically, this test reveals the notorious steroid diabetes mellitus and electrolyte disturbances.
Therapy
And this nuance needs to be given a little attention, since we are talking about the causes and symptoms of hypercortisolism. Treatment of pathology depends on the cause of its occurrence.
If, for example, a drug (iatrogenic) form of the disease is diagnosed, then the path to healing lies through the abolition of glucocorticoids, as well as their further replacement with any other immunosuppressants. When a person has a pathology of an endogenous nature, he is prescribed medication that suppresses steroidogenesis.
In some cases, a tumor lesion of the adrenal glands, lungs or pituitary gland is detected. Then the solution is surgery. Because in such cases, neoplasms can only be removed with the help of an operation.
However, sometimes intervention is unrealistic for one reason or another. Then the patient is prescribed an adrenalectomy, in which the entire adrenal gland is amputated. An alternative is radiation therapy of the hypothalamic-pituitary region. Although it is often combined with drug or surgical treatment. This approach helps to strengthen and consolidate the effect of therapy.
But that's not all there is to know about managing symptoms and treating hypercortisolism. The diagnosis is serious, and therefore can not do without drug therapy, even if surgery is indicated. The patient is prescribed a range of medications, including:
- Antidepressants.
- Antihypertensive drugs.
- Diuretics.
- Biostimulants.
- Drugs that lower sugar.
- Cardiac glycosides.
- Immunomodulators.
- Sedatives.
- Vitamins.
If the patient has developed osteoporosis, he will be shown symptomatic treatment. Compensation is requiredcarbohydrate, mineral and protein metabolism.
But the most responsible and important is postoperative treatment. If the patient has undergone an adrenalectomy, then he will have to constantly adhere to hormone replacement therapy. Without it, his body will not be able to function normally.
Forecast
Studying the specifics of such a serious disease, it is necessary to answer a very important question: what are the chances of recovery from this pathology? What is the prognosis? The symptoms of hypercortisolism and its manifestations are severe, this could be seen from the foregoing. And, unfortunately, if pathology is ignored, the risk of death is extremely high. Mortality reaches 40-50%.
The prognosis is satisfactory if the cause of the pathology is a benign corticosteroma. But again, the function of a he althy adrenal gland is restored only in 80% of patients.
If a malignant corticosteroma has been diagnosed, then the prognosis of a 5-year survival rate will be approximately 20-25%. This is about 14 months on average.
In all cases, the prognosis is determined by how timely treatment was started. Therefore, it is impossible to delay the diagnosis in any case. The more advanced the case, the more serious the complications, the shorter the patient's life will be. That is why it is highly recommended to undergo a general examination at least once a year to ensure your good he alth. And if a problem is discovered, then at least it will be possible to take it under medical control in time.
