Being fat with a medical cause: Cushing’s Syndrome

Being fat is often annoying and losing weight is the solution. But what if you cannot lose weight because being fat is not your own fault, but the result of a medical condition? In this article you can read more about a syndrome that makes you fat through no fault of your own: Cushing’s Syndrome. Some people may recognize it from an episode of Dr. House.

Cushing’s syndrome

  • Cushing’s syndrome: introduction
  • The symptoms
  • The causes
  • The treatment

 

Cushing’s syndrome: introduction

Cushing’s Syndrome is the name for the combination of a number of different clinical symptoms, all of which are caused by too high cortisol levels in the blood. This striking increase is almost always the result of excessive production of this substance in the adrenal glands (hypercortisolemia). This cortisol is a type of hormone that increases the glucose level in the blood. We call this hyperglycemia. The body responds immediately to this and starts producing insulin. If the body produces excessive insulin and cortisol for a long time, fat will accumulate and people will become fat. In addition to fat accumulation, the high insulin level also almost always causes diabetes mellitus. Because the amount of cortisol is so high, proteins in the muscles, skin and hair are broken down. The cortisol also ensures that the hormone ADH can do its job less well, causing you to urinate a lot. We call this polyuria.

The symptoms

People with Cushing’s syndrome will often suffer from most of the following symptoms:
An abnormal fat distribution: a lot of fat on the abdomen and neck, with often thinner arms and legs due to muscle breakdown (central adiposity).

  • Becoming much fatter (sometimes with only slight weight gain)
  • A moonface (moon-shaped face, relatively round face)
  • A hump of fat high against the neck on the back (also called bison neck)
  • Thinning skin with increased risk of bruising
  • Stretch marks on the abdomen and buttocks (stretch marks) due to the combination of fat gain and thinning skin
  • Rapid fatigue with little effort
  • Decrease in muscle strength
  • Thinning hair
  • Having to urinate more often than normal
  • Infertility and decrease in interest in sex

 

The causes

There are two main causes of Cushing’s Syndrome. Firstly, this is the excessive production of cortisol in the adrenal glands, which can arise in different ways. The second cause is excessive production of the hormone ACTH in the pituitary gland in the brain. But there are also other less common causes such as previous medical treatment using corticosteroids, very severe depression, excessive production of the hormone CRH by the hypothalamus or a tumor that produces the hormone ACTH, which is sometimes the case. can be the case, for example, with lung carcinoma.

The treatment

The treatment depends entirely on the cause. Recently, it has become increasingly common for people to suffer from Cushing’s Syndrome due to an iatropic cause, i.e. due to medical treatment for another condition. In this case it concerns the administration of steroids. If this is the case, this treatment will have to be discontinued. Stopping treatment abruptly can be dangerous. For example, it can lead to Addison’s disease .
If the symptoms are caused by a tumor, the tumor will of course have to be surgically removed. Even if that is not the cause, surgical intervention will sometimes be performed, for example to remove one or both adrenal glands. However, steroids are often administered after the operation, in many cases prednisol, again to ensure that the intake of these comes to an abrupt end. If the adrenal glands are completely removed, one will have to take medications for a lifetime to take over the function of the organ. If this is not done sufficiently , Nelson’s Syndrome can occur.
A number of types of medicines have been developed for people who cannot or do not want to undergo surgery, such as ketoconazole and metyrapone. However, its effect is limited.

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