What is Cushing's Syndrome? Hypercortisolism, definition, causes, sign and symptoms, medical and Physiotherapy Management

Definition

It is a disorder caused by prolonged exposure to high levels of the hormone cortisol. This can occur due to a tumor on the pituitary gland that produces ACTH, a hormone that stimulates the adrenal glands to produce cortisol, or a tumor on the adrenal glands themselves that produces cortisol. 

Causes of Cushing's syndrome

This can be caused by several factors, including:

Pituitary gland tumors: A tumor on the pituitary gland can cause it to produce too much ACTH, which stimulates the adrenal glands to produce excessive amounts of cortisol.

Adrenal gland tumors: Tumors on the adrenal glands themselves can cause them to produce too much cortisol, independent of ACTH levels.

Medications: Long-term use of corticosteroids, such as prednisone.

Ectopic ACTH production: In rare cases, tumors outside of the pituitary or adrenal glands can produce ACTH and lead to Cushing's syndrome.

Sign and Symptoms of Cushing's Syndrome

The signs and symptoms of Cushing's syndrome include:

• weight gain
• Fatigue
• Weakness
• Skin that bruises easily
• Purple stretch marks on the skin
• Increased thirst and urination
• High blood pressure
• Headaches
• Anxiety, depression or irritability
• Lack of menstrual periods in women
• Fertility problems in men and women
• Muscle weakness
• Bone loss, which can lead to osteoporosis and fractures
• Acne
• Excess hair growth in women

Medical treatment for Cushing's syndrome 

The treatment for Cushing's syndrome depends on the underlying cause of the condition. If it is caused by the use of exogenous corticosteroids, the treatment is to gradually decrease the dose of the medication. If it is caused by a tumor on the pituitary gland, surgery to remove the tumor may be necessary. In cases where the tumor is located on the adrenal gland, surgery to remove the tumor or radiation therapy may be recommended. In some cases, medical therapy with medications such as ketoconazole or metyrapone may be used to decrease the production of cortisol by the adrenal glands. In situations where these treatments are not effective or not possible, a medication called Pasireotide can be used. It is a somatostatin analog which reduce ACTH secretion.

Role of physiotherapy in Cushing's syndrome management 

In the management of Cushing's syndrome, physiotherapy plays an important role in helping to alleviate the musculoskeletal symptoms and complications that can occur as a result of the condition. These include:

Muscle weakness: Cushing's Syndrome can lead to muscle weakness and wasting, physiotherapy can help to improve muscle strength and endurance through exercises such as resistance training.

Osteoporosis: Cushing's Syndrome is associated with an increased risk of osteoporosis, physiotherapy can help to prevent bone loss through weight-bearing exercises and education on proper posture and body mechanics.

Joint pain: Cushing's Syndrome can cause joint pain and stiffness due to muscle weakness and the development of fatty deposits in the joints. Physiotherapy can help to alleviate this pain through the use of techniques such as joint mobilization and soft tissue mobilization.

Balance and gait disturbances: Cushing's Syndrome can cause balance and gait disturbances, physiotherapy can help to improve balance and gait through exercises such as balance training and gait retraining.

Rehabilitation following surgery: physiotherapy can be used to help a person regain their strength and mobility following surgery for Cushing's Syndrome.

Overall, physiotherapy plays a crucial role in the management of Cushing's syndrome, by helping to alleviate symptoms, prevent complications, and aid in the recovery process.