Cushing's 101
- Stephanie Tiller
- 13 hours ago
- 3 min read
Updated: 3 hours ago
I realized I was getting a bit ahead of myself. :) Before I can tell my story and how I have been impacted, I need to explain the Cushing's world a bit.
How familiar are you with Cushing's Syndrome?
0%I have never heard of Cushing's before
0%I know someone with Cushing's but I don't know much about it
0%I understand the basics (types/symptoms/causes/treatments)
0%I am very familiar/expert level (personal or professional)
All types of Cushing's are the result of excess and extended exposure of cortisol in the body.
Cushing Syndrome Types:
Exogenous: external factors like taking steroid medications
Endogenous: tumor(s) on adrenal gland(s), pituitary gland, or ectopic tumors producing ACTH
Consider this post as studying film/preseason:
In 1912, Harvey Cushing (a neurosurgeon with Johns Hospkins) identified commonalities in patients with hypercortisolism (excess cortisol in the body). The HPA axis (hypothalamus - pituitary - adrenal) is a self-regulating system that functions as a negative feedback loop.
Normal HPA Axis:
The HPA axis functions as the central hub for regulating your body's stress-response system. It keeps your body alive during times when something stressful happens (illness, injury, pain, trauma, emotional stress, infections, sleep deprivation, blood sugar drops, blood pressure drops, cardiac changes, etc.).
From a biochemical perspective, when any form of stress occurs, the hypothalamus releases CRH (Corticotropin-Releasing Hormone) and sends it to the pituitary gland. Upon receipt, the pituitary gland releases ACTH (Adrenocorticotropic Hormone) to the adrenal glands. When that is received by the adrenal glands, it tells them to produce cortisol. The adrenal glands produce enough cortisol to counteract whatever stressor is being put on the body. The cortisol goes back to the hypothalamus & pituitary gland and that says, "Okay, we have enough! You can stop sending CRH & ACTH!". That prevents overproduction production of cortisol.
The self-regulating, negative feedback loop.
Regardless of the cause, Cushing's occurs when there is a dysregulation in the HPA axis and it results in excess cortisol.
The cause can be exogenous (impacts from outside of the body, like taking steroids) or endogenous (something that is occurring inside the body).
Exogenous Cushing Syndrome includes any external impacts (essentially taking any type of glucocorticoid in a form of medication for another ailment). Some medications are prednisone, hydrocortisone, dexamethasone, inhalers, topical steroids, joint injections, etc. When these medications are prescribed, it's generally to control inflammation or pain. Your body's natural cortisol does this, but if there is another condition that causes severe inflammation or pain (think Crohn's or many rheumatoid-related conditions), the body requires additional support to control that inflammation or pain beyond what the body can produce. When these steroid medications are taking at high dosages, for extended periods of time, it shuts down the body's natural HPA axis feedback loop. This is typically easier to recover from as steroids are just tapered and discontinued.
Endogenous Cushing Syndrome can be divided into two categories ACTH-dependent and ACTH-independent.
ACTH-dependent: in this case, there is an excess production of ACTH, which leads to an increase in cortisol. The cause of excess ACTH can be from a (generally benign) tumor on the pituitary gland - called Cushing's Disease or tumors elsewhere in the body that are making ACTH - Ectopic ACTH Syndrome.
ACTH-independent:
(1) Adrenal adenoma (benign) - My Diagnosis (I had a 4.8cm tumor on my right adrenal gland) full post to follow
(2) Adrenal carcinoma (malignant) - cancer *I know very little about this because fortunately, my tumor was benign.
(3) Bilateral adrenal hyperplasia (micronodular (PPNAD) and macronodular (AIMAH) * I know very little about this it means that they are tumors on both adrenal glands and they could each have one or each have many, but in this case both adrenals are impacted.
A Few Things to Note: In medical literature, it is referred to as "Cushing Syndrome" whereas in more common vernacular it is referred to as "Cushing's Syndrome". For me, personally, I typically use "Cushing Syndrome" or ECS when I am referring to my specific Endogenous Cushing Syndrome diagnosis. "Cushing" or "Cushing's" can be used interchangeably. For the sources that I cite, I will provide direct links to the articles or themselves or where they have been published (some are free, some are paid.
*For this particular Cushing's 101 overview, I have read countless articles and textbooks, but if you would like to learn more here are a few top sources:
Next up:
A deep dive into my specific diagnosis: ACTH-independent Endogenous Cushing Syndrome
Thank you for reading :)
Comments