Hypercorticism, the symptoms and causes of which will be discussed in the article, is a disease characterized by a prolonged chronic exposure to the body of hormones of the adrenal cortex in an abnormal, excessive amount. This pathology is also called Itsenko-Cushing's syndrome. And now it will be described in detail.
Causes
Before considering the symptoms of hypercorticism, we must briefly talk about the pathology itself. There are only two reasons why it may arise:
- Long-term treatment with glucocorticoids.
- Increased secretion of cortisol by the adrenal cortex.
In simpler terms, the reason is always a hormonal disorder. 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. Usually athletes are prone to this. Still cortisol is actively produced in the organisms of women bearing a fetus. In pregnant women, the level of this hormone in the last months of the term increases significantly.
More cortisol is produced in large quantities by alcoholics, heavy smokers and drug addicts. Also at risk are people suffering from any kind of mental disorder.
Predisposing factors
Symptoms of hypercorticism can be expected in the case of one of the following circumstances:
- The presence of a hereditary predisposition (problems with the endocrine system that relatives had).
- The passage of a long therapeutic course, involving the administration of glucocorticoid hormones. Especially great risk with the use of 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.
- Adrenal adenomas (benign tumors).
Classification
She should pay a little attention before talking about the symptoms and diagnosis of hypercorticism. This pathology is of three types:
- Endogenous. The disease occurs due to internal disorders occurring in the body. In about 70% of cases, Itsenko-Cushing's disease becomes the cause. This is not the same syndrome. The names are similar, but the pathologies themselves are not similar. Itsenko-Cushing's disease is characterized by increased production of the pituitary adrenocorticotropic hormone. By the way, it stimulates the release of cortisol from the adrenal glands.
- Exogenous. Symptoms characterized by cushingoid syndrome, this type of hypercorticism are most characteristic. This is the most common type of pathology. The reason for the formation is a long treatment with steroids. Glucocorticoids usually treat rheumatoid arthritis, asthma, or immunosuppression.
- Pseudo-syndrome. Sometimes, for certain symptoms and manifestations, one gets the impression that a person suffers from hypercorticism. The results of a general diagnosis may even indicate this (which is why it is important to conduct a differentiated one as well). Not always specific symptoms suggest that the patient has true hypercorticism. And the common causes of pseudosyndrome are obesity, pregnancy, alcohol intoxication, depression and stress. Less commonly, oral contraceptives containing progesterone and estrogens are used. Even in an infant, a pseudosyndrome may occur, since substances that are present in the mother's body and cause this ailment enter his body along with breast milk.
Be that as it may, the diagnosis will need to be passed, and treatment will be prescribed. But what exactly - the endocrinologist will decide, 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 hypercorticism. The most characteristic sign is obesity. It is observed in more than 90% of patients with this diagnosis. Moreover, body fat is very uneven. They are localized on the back, stomach, chest, neck, face. The limbs can be relatively thin.
Another symptom of hypercorticism observed in men and women is a moon-shaped red-crimson face, which has a cyanotic hue. This is also called "matronism." In addition to this symptom, a "climacteric" hump is also seen. 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 is thinning, becoming almost transparent. This is especially noticeable on the back of the palms.
Disorders in the muscular system
Continuing to study the symptoms of hypercorticism (Itsenko-Cushing's syndrome), it is also necessary to make a reservation that with this ailment, the tone and strength of the muscles decrease, as well as the muscles atrophy. All these changes are manifested by 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 stomach", manifested by malnutrition.
Often a hernia of the white line of the abdomen is formed. Preperitoneal tissue and 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 tumor-like protrusion: it can be seen with the naked eye.
Skin changes
Continuing the story about the causes and symptoms of hypercorticism, it should be noted that the integument in people suffering from this disease has a characteristic “marble” hue. A vascular pattern is obvious on the skin, it itself is prone to dryness and peeling, in some places it is interspersed with separate areas of sweating.
If you pay attention to the skin of the hips, buttocks, abdomen, mammary glands and shoulder girdle, you can notice stretch marks. These are striae of cyanotic or crimson 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.
Also, patients suffer from acne, they have spider veins, subcutaneous hemorrhages, and in some areas hyperpigmentation occurs.
Bone problems
Their appearance is also a symptom of hypercorticism in women and men. In the presence of this disease, bone tissue is damaged and thinning, which leads to the development of osteoporosis. Its signs are severe pain, bone deformation (fractures are also possible), scoliosis and kyphoscoliosis. The thoracic and lumbar region is especially affected.
Due to compression of the vertebrae, people seem to lose growth, gain stoop. If Itsenko-Cushing's syndrome is diagnosed in a child, then it lags behind in physical development. The reason is a slowdown in the development of epiphyseal cartilage.
Other changes
In addition to the listed symptoms, there are many other symptoms of hypercorticism, which are also the consequences of this ailment.
From the side 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 psychoses. Some patients experience euphoria, others experience suicidal attempts.
Another 10-20% of people suffering from hypercorticism develop the so-called steroid diabetes mellitus, which is in no way associated with pancreatic disease. The disease is relatively easy: it can be quickly compensated by taking drugs that reduce sugar, as well as observing an individual diet.
Considering the symptoms of hypercorticism in men and women, it should also be noted that often this ailment becomes the cause of the development of poly- and nocturia and edema (peripheral).
Manifestations of an ailment depending on gender
The signs of this disease are the same in all patients. However, in addition to all of the above, men and women face purely individual changes in their organisms. This is logical, because the hormonal background has a gender specificity.
In women with this pathology, infertility, amenorrhea, hypertrichosis, hirsutism and virilization often occur. The menstrual cycle is also disturbed.
And men have obvious signs of feminization. Testicles can atrophy, often libido and potency decrease, gynecomastia occurs.
Diagnostics
Much has been said above about the symptoms of hypercorticism in men and women. The treatment will be discussed further, and now a little attention needs to be paid to the issue of diagnosis.
The basis for suspicion of the pathology in question is physical and amnestic data. As part of the diagnosis, the first thing that is determined is the reason why hypercorticism arose. For these purposes, screening tests are performed. Namely:
- Examination of daily urine for cortisol excretion. If the level is 3-4 times higher than normal, then hypercorticism is diagnosed.
- Small dexamethasone sample. If a person is healthy, then taking this drug will reduce the level of the hormone by half at least. With hypercorticism, this does not happen.
An increased content of 11-ACS in the urine and a low level of 17-CS are also detected. Hypokalemia, increased cholesterol and red blood cells are observed.
In order to determine what exactly became the source of the pathology, CT or MRI, as well as adrenal scintigraphy, are performed. If the doctor considers it necessary, then he appoints a biochemical blood test. Usually in the course of this study, the notorious steroid diabetes mellitus and electrolyte disorders are detected.
Therapy
And this nuance needs to be paid a little attention, since we are talking about the causes and symptoms of hypercorticism. Treatment of pathology depends on the cause of its occurrence.
If, for example, a medicinal (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 immunosuppressive drugs. When a person has a pathology of endogenous nature, he is prescribed a medication that suppresses steroidogenesis.
In some cases, a tumor of the adrenal gland, lungs, or pituitary gland is detected. Then surgical intervention becomes the way out. Because it is possible to remove neoplasms in such cases only with the help of surgery.
However, sometimes the intervention is unrealistic for one reason or another. Then the patient is prescribed an adrenalectomy, in which an 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 eliminating symptoms and treating hypercorticism. The diagnosis is serious, and therefore can not do without drug therapy, even if surgery is indicated. The patient is prescribed a number of drugs, among which:
- Antidepressants.
- Antihypertensive drugs.
- Diuretic drugs.
- Biostimulants.
- Sugar-lowering medicines.
- Cardiac glycosides.
- Immunomodulators.
- Sedatives.
- Vitamins
If the patient has developed osteoporosis, then he will be shown symptomatic treatment. Compensation of carbohydrate, mineral and protein metabolism is also mandatory.
But the most responsible and important is postoperative treatment. If the patient has undergone adrenalectomy, then he will have to constantly adhere to hormone replacement therapy. Without this, his body will not be able to function normally.
Forecast
Studying the specifics of such a serious disease, it is necessary to give an answer to a very important question: what are the chances of recovery with this pathology? What is the forecast? Symptoms of hypercorticism and its manifestations are severe, this could be seen from the foregoing. And, unfortunately, when ignoring pathology, the risk of death is extremely high. Mortality reaches 40-50%.
The prognosis is satisfactory if benign corticosteroma is the cause of the pathology. But again, functions of a healthy adrenal gland are restored only in 80% of patients.
If malignant corticosteroma was diagnosed, then the prognosis of 5-year survival 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. And therefore, it is impossible to delay the diagnostics in any case. The more advanced the case, the more serious the complications, the shorter the patient’s life. That is why it is strongly recommended that you undergo a general examination at least once a year to make sure that you are in good health. And if a problem is discovered, then at least it will be possible to take it under medical control in time.