Understanding Cushing Syndrome: Symptoms, Diagnosis, and Treatment

Cushing syndrome is a condition characterized by excessive levels of cortisol in the body, which can lead to a variety of health issues. This hormonal imbalance can occur due to various factors, the most common being the use of glucocorticoid medications. Symptoms of Cushing syndrome are often insidious, leading to delays in diagnosis, particularly in women who are more commonly affected. Recognizing the signs early can significantly improve patient outcomes.

A full blood count is an essential initial step in evaluating patients suspected of having hormonal disorders. In cases where hemoglobin levels are low, such as 100 g/L, with an elevated mean cell volume (MCV) of 110 fl, further investigation may be needed. A likely diagnosis could include secondary hypoadrenalism, where insufficient production of adrenocorticotropic hormone (ACTH) from the pituitary leads to inadequate cortisol production from the adrenal glands. Additional testing may include measuring ACTH levels to confirm the underlying cause.

Treatment for Cushing syndrome often involves glucocorticoid replacement therapy, especially in cases of adrenal insufficiency. It's important to adjust doses during periods of illness or stress, often doubling the usual dose to manage potential adrenal crises. Patients should also carry a steroid alert card or bracelet to inform healthcare providers about their condition. Fludrocortisone is typically not required unless mineralocorticoid deficiency is present.

Diagnosis of Cushing syndrome requires proving cortisol excess rather than relying solely on random plasma cortisol levels, which are influenced by various factors throughout the day. Instead, more reliable tests such as 24-hour urinary free cortisol measurement or late-night salivary cortisol can be used to assess cortisol levels accurately.

In addition to Cushing syndrome, it's necessary to consider associated disorders that may explain hematologic findings, such as adrenal tumors or pituitary adenomas. These conditions can lead to a range of symptoms and require comprehensive evaluation and management strategies to address both hormonal and hematologic abnormalities effectively.