Cushing's Syndrome: Symptoms and Diagnosis Insights

Q: Cushing's Syndrome: Symptoms and Diagnosis Insights

Hello： It is recommended to visit a hospital for evaluation and examination by a physician. <br>A diagnosis can only be made after a thorough consultation and examination; one should not rely solely on personal subjective feelings to make a diagnosis.

Cushing's syndrome endocrine disorder

Hello, doctor.
For the past month, I have not had my period.
My face appears round, and I have what seems to be "buffalo hump" at my collarbone.
My mood has become depressed and irritable.
My hands have become dry and even cracked.
I have developed acne and comedones on my chin and philtrum, and there are multiple areas on my body with acne and comedones.
My cheeks have become red, and my blood vessels are more prominent.
I am experiencing constipation, and my abdomen has slightly enlarged.
My legs are swollen to the point where my ankles are not visible.
My sleep duration has decreased to about 4.5 hours, but I feel quite energetic.
My appetite is extremely good.
This has been ongoing for about a month.
Recently, aside from the constipation resolving, my abdomen shrinking, my sleep duration increasing, and significant improvement in my mood and temper, I have started to feel cold and become easily fatigued with lower back pain.
The swelling in my legs has disappeared, and my appetite has returned to normal.
However, the round face, buffalo hump, widespread acne and comedones, facial redness, absence of menstruation, and dry hands persist.
Could this be Cushing's syndrome, or is it hypothyroidism?

A-Nan, 20~29 year old female. Ask Date: 2021/10/09

Dr. Lin Jianliang reply Internal Medicine

Hello: It is recommended to visit a hospital for evaluation and examination by a physician.
A diagnosis can only be made after a thorough consultation and examination; one should not rely solely on personal subjective feelings to make a diagnosis.

Reply Date: 2021/10/09

More Info

Cushing's Syndrome, also known as hypercortisolism, is a condition characterized by excessive levels of cortisol in the body. This can result from various causes, including pituitary adenomas (Cushing's disease), adrenal tumors, or ectopic ACTH production. The symptoms you describe—moon facies, buffalo hump, mood changes, skin issues, and menstrual irregularities—are indeed consistent with Cushing's Syndrome.
The symptoms you are experiencing, such as the moon face, buffalo hump, and mood changes, are classic indicators of Cushing's Syndrome. Additionally, the presence of acne and skin changes, along with weight gain and menstrual irregularities, further supports this possibility. The fact that you have experienced significant mood fluctuations, including feelings of depression and irritability, is also noteworthy, as psychological symptoms are common in individuals with this condition.

However, it is essential to differentiate between Cushing's Syndrome and other potential conditions, such as hypothyroidism. Hypothyroidism can also lead to symptoms like fatigue, weight gain, and mood changes, but it typically presents with additional signs such as cold intolerance, hair loss, and dry skin. The symptoms you mentioned, such as the sudden onset of cold intolerance and fatigue, could suggest a thyroid issue, but the more prominent features align more closely with Cushing's Syndrome.

To accurately diagnose your condition, a thorough evaluation is necessary. This typically involves:
1. Hormonal Testing: Initial tests often include measuring cortisol levels in the blood, urine, or saliva. A 24-hour urinary free cortisol test is commonly used to confirm hypercortisolism. Late-night salivary cortisol tests can also be informative, as cortisol levels should be low at night.

2. ACTH Levels: Measuring adrenocorticotropic hormone (ACTH) levels can help determine the cause of Cushing's Syndrome. If ACTH is low, it suggests an adrenal cause (like an adrenal tumor). If ACTH is high, it may indicate a pituitary cause (Cushing's disease) or ectopic ACTH production.

3. Imaging Studies: If hormonal tests confirm Cushing's Syndrome, imaging studies such as MRI of the pituitary gland or CT scans of the adrenal glands may be performed to identify any tumors or abnormalities.

4. Thyroid Function Tests: Given your symptoms, it would also be prudent to check your thyroid function through TSH and free T4 levels to rule out hypothyroidism.

In your case, it is crucial to consult an endocrinologist who specializes in hormonal disorders. They can guide you through the necessary tests and help interpret the results accurately. Given the complexity of hormonal interactions and the overlapping symptoms of various endocrine disorders, a specialist's insight will be invaluable.

In summary, while your symptoms are suggestive of Cushing's Syndrome, a definitive diagnosis requires comprehensive testing. It is essential to address these concerns promptly, as untreated Cushing's can lead to significant health complications, including cardiovascular disease, diabetes, and osteoporosis. Early diagnosis and treatment can improve your quality of life and mitigate the risks associated with prolonged cortisol excess.

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