Cushing’s syndrome

Abstract

Cushing’s syndrome (CS) is a symptom complex resulting from chronic exposure to excess glucocorticoids. Patient can present with varying subclinical, cyclical or mild to rapid-onset severe symptoms, and they have debilitating morbidities and enhanced mortality. Exogenous corticosteroid exposure is the most common cause of CS. CS is the most common cause of endogenous hypercortisolism. An early confirmation of hypercortisolism causes identification, and optimum treatment is important for better long-term outcomes. Presence and severity of symptoms depends on degree and duration of hypercortisolism and presence or absence of androgen excess. For diagnosis, two questions need to be answered: whether patient has biochemical hypercortisolism and what is the cause or source of hypercortisolism in the body. Night salivary cortisol has a sensitivity of 92-100% and specificity of 93-100%. After biochemical diagnosis, imaging studies are performed. Transsphenoidal surgery is the initial treatment for Cushing’s disease. Laparoscopic adrenalectomy is preferably the treatment of choice in adrenal origin CS. In ectopic adrenocorticotropic hormone (ACTH) syndrome, bilateral adrenalectomy with resection of the source of ACTH, where possible, is the first-choice treatment. CS causes significant impairment in quality of life, but it improves partially in long term after remission of the disease.