Symptoms of Itsenko-Cushing syndrome, features of treatment

Itsenko-Cushing syndrome often appears with prolonged or frequent treatment with hormonal drugs due to increased production of corticosteroid hormones, as well as for a number of other reasons. This pathology is quite serious, so it is important to pay attention to the symptoms in order to start treatment in time.

Syndrome description

Cushing's syndrome occurs when excessive work of the adrenal glands, because of which the body is oversaturated with cortisol. This can be eliminated by the pituitary gland, which produces adrenocorticotropic hormone. However, the hypothalamus affects the pituitary gland, which in turn produces liberins and statins.

As a result, a peculiar chain of actions is formed. In case of violation of any link, an increased secretion of the adrenal cortex occurs.

As a result, Itsenko-Cushing syndrome develops. Exceeding the amount of cortisol in the body leads to the breakdown and splitting of protein compounds, due to which many tissues and structures begin to change. First of all, bones, skin, muscles, organs are affected. The farther the processes of decay, the more pronounced the processes of dystrophy and atrophy. Also disrupted carbohydrate metabolism.

The main forms of this syndrome:

1. ACTH, or dependent form. It includes the syndrome of ectopic production of ACTH, when the level of TSH increases. As a result, separate zones of the adrenal glands grow, which is why cortisol and androgens are produced in large quantities than the body requires. This form of the disease accounts for about 20% of cases. Sometimes patients may even lack signs of elevated glucocorticosteroids. This condition is caused by the rapid development of the disease. Most often, this type of disease is characteristic of people who have small cell lung cancer.
2. Independent Cushing syndrome. Primary neoplasms in the adrenal glands or their nodular growth most often lead to the occurrence of this condition. With this syndrome, the production of ACTH by the pituitary gland is suppressed. In 70% of cases, this form appears due to the presence of benign adrenal tumors. Moreover, this form of pathology affects women almost 10 times more often than men.

What are the causes of development?

This table will tell you more about the causes, people who are at risk:

Symptoms of Itsenko-Cushing syndrome

The clinical manifestations of this syndrome are specific and diverse. With this pathology, dysfunction of the nervous, cardiovascular and reproductive systems develops.

The first sign of illness is morbid obesity, which is characterized by an uneven deposition of fat over the body. However, most often the subcutaneous fatty tissue is most pronounced in the neck, chest, abdomen, face. The face becomes like the moon, acquires a purple hue, an unnatural blush.

The figure of patients with Cushing's syndrome becomes irregular. There are stripes or stretch marks of a crimson-bluish tint. This is caused by overstretching of thinned skin.

The skin manifestations of this syndrome also include:

• acne;
• acne;
• hematomas;
• slow wound healing.

Over time, the skin gets a marble shade with a pronounced vascular pattern. On the elbows, neck, abdomen, the skin can change color, which is caused by excessive deposition of melanin.

With this pathology there is a lesion of the muscular system, which is expressed in the malnutrition or hypertonia of the muscles. This is due to trophic processes in the muscles.

Sexual dysfunction is also associated with this pathology. It manifests itself as a violation of the menstrual cycle in women, a decrease in sexual desire in men.

Another symptom is osteoporosis, that is, a decrease in bone density.

It occurs in severe metabolic disorders in the bones, when catabolism prevails over bone formation processes. With the defeat of the nervous system in patients may experience various disorders: inhibition, apathy, depression. Insomnia and psychosis may also occur. Disorders of the central nervous system are manifested in constant aggression, anger, anxiety.

Common symptoms include:

• weakness;
• headaches;
• fatigue;
• thirsty;
• frequent urination.

Cushing's syndrome may be mild, moderate or severe. The progressive course of the disease is characterized by an increase in symptoms, the gradual development of symptoms occurs within 10 years.

In children, the symptom is diagnosed very rarely. But the first sign of the disease is obesity, and puberty can also be delayed. Boys may have hypoplasia of the genital organs, girls have ovarian dysfunction, no menstruation.

Signs of damage to the central nervous system, bones, skin are similar to those in adults. But pregnancy in women, which suffers from Cushing's syndrome, rarely occurs due to sexual dysfunction. How much is the prognosis of pregnancy unfavorable: premature birth, spontaneous abortion in the early period may occur.

In the absence of timely treatment, this syndrome can lead to the development of serious complications:

• sepsis;
• heart failure;
• violation of cerebral circulation;
• osteoporosis;
• bacterial or fungal inflammation of the skin;
• diabetes;
• urolithiasis disease.

Diagnostic measures

The diagnosis of this syndrome is based on the patient's complaints, the results of screening tests. The specialist begins with a general examination, paying attention to the degree and nature of body fat, the condition of the skin of the face, examines the results of analyzes:

1. In the urine of patients determine the level of cortisol. If it exceeds the norm by 3-4 times, the diagnosis is confirmed.
2. Test with dexamethasone. In healthy people, this drug reduces cortisol levels, in patients this does not occur.
3. Hemogram.
4. Blood chemistry. In Cushing's syndrome, hyperglycemia, hypercholesterolemia is observed.
5. In tests for markers of osteoporosis, low osteocalcin levels can be detected - this is a marker of bone formation.
6. Analysis of the TSH. With this pathology, the level of thyroid stimulating hormone decreases.
7. Tomographic study of the pituitary and adrenal glands to determine oncogenesis, its size, location.
8. X-ray examination of the skeleton should determine the signs of osteoporosis or the presence of fractures.
9. Additional diagnostic method - ultrasound of internal organs.

How is the treatment?

To get rid of this syndrome, first of all you need to identify the cause, then normalize the level of cortisol in the blood. If the disease was caused by therapy with glucocorticoids, they should be gradually canceled or replaced with other drugs.

Medication Treatment

Patients with Cushing's syndrome are prescribed inhibitors of adrenal synthesis of glucocorticoids, such as Ketoconazole.

Also symptomatic treatment is carried out:

• diuretics, such as furosemide;
• antihypertensive drugs - Capoten or Bisoprolol;
• hypoglycemic agents - Diabeton, Siofor;
• cardiac glycosides - Strofantin;
• immunomodulators - Immunal;
• sedatives - Corvalol and Valocordin;
• multivitamin complexes.

Surgery

Surgery for this syndrome is to conduct the following types of operations:

1. Adrenalectomy. This is the removal of the affected adrenal gland. In case of benign neoplasms, partial andrenalectomy is performed - in this case only the tumor is removed, and the organ is retained. In the future, the biomaterial is sent for histological examination to obtain information about the type of tumor. After performing such an operation, the patient will need to take glucocorticoids throughout his life.
2. Selective adenomectomy. This is the most effective way to get rid of the problem. Neoplasms of the pituitary gland remove neurosurgeons through the nasal cavity. The patient is quickly rehabilitated and returns to his usual way of life. If the tumor is located in the pancreas or other organs, it is removed with minimally invasive intervention.
3. Adrenal destruction is another treatment that eliminates hyperplasia by injecting a sclerosing substance through the skin.

Forecasts

Cushing's syndrome is a serious illness that does not go away in a few days. And in two out of ten cases (if there is no timely treatment) the probability of death is 40%. It occurs as a result of irreversible changes in the body.

However, there are several recommendations that doctors give:

1. It is necessary to gradually increase physical exertion, return to the usual rhythm of life, using light workouts without overwork.
2. It is necessary to adhere to a proper, balanced diet.
3. Be sure to perform any mental gymnastics, for example, logic exercises, tasks and rebuses.
4. Normalization of psycho-emotional state will help to cope with the disease faster.
5. It is necessary to observe the optimum mode of work and rest.

If there are malignant tumors with this syndrome, the prognosis may not be entirely favorable. Only in 20% of cases after the performed operation is a positive result possible. But if the tumor has a benign origin, then after surgical removal, positive dynamics is observed in 100% of cases.

Watch the video: Cushing Syndrome - causes, symptoms, diagnosis, treatment, pathology (May 2024).