Obesity

Cushings Syndrome – A Reason For Central and Upper Body Obesity

It is unfortunate that more than half of the American population is battling obesity. A study projects that by the year 2018, 21% of the nation’s direct health care spending will be on obesity related causes. It is a known fact that lifestyle choices have a significant impact on weight gain. But sometimes certain clinical conditions can make it hard to lose weight.

Cushings Syndrome

is one such condition that has been extensively linked to upper body and central obesity. It is a disorder caused by elevated levels of cortisol in blood. This condition could be caused by the formation of tumors in the pituitary glands that produce cortisol or adrenocorticotropic hormone (ACTH). ACTH itself, further increases the level of cortisol in blood. The secretion of this hormone is regulated by the pituitary gland. It secretes the ACTH hormone which in turn helps the adrenal glands to secrete cortisol.

The levels of cortisol can also increase in blood because of taking glucocorticoids which are artificial steroid hormones. Steroids containing artificially synthesized ACTH hormone used for the treatment of chronic conditions of rheumatoid arthritis and asthma can also lead to the said condition.

Some physicians and researchers are of the opinion that it could be inherited.

Symptoms of Cushings Syndrome

  • Very fast weight gain in the upper and central part of the torso. The limbs remain thin with a bloated mid section.
  • Fat gets padded on in the back of the neck and is termed as a buffalo hump .
  • Fat gets padded around the abdomen and causes central obesity.
  • It might get added on to the facial terrain and give it a round appearance as in a moon face.”
  • Patients can become weak, fragile and emaciated and get bruised easily. Stretch marks having pink or purplish hues are common on skin.
  • Severe tiredness and fatigue.
  • Hypertension.
  • Stress, hypertension, depression and irritability.
  • Decreased libido and irregular menstruation.
  • Hirsutism.
  • Insomnia.
  • Insulin resistance with increased risk of diabetes mellitus.

This condition can increase the risk of abdominal obesity and upper body obesity many times. Abdominal obesity in turn can increase the risks of heart disease, dementia and other co morbidities. About 350,000 people die due to obesity related diseases every year. Obesity caused by the said condition can co exist with diseases like cancers.

Diagno

sis

The diagnosis of this syndrome is very important as it can be the missing link for the abnormal weight gain in an individual in spite of watching out one’s diet and exercising. The tests to diagnose the condition are as follows:

  • Urine Test

    : Urine samples collected every couple of hours for a 24 hour period may be used to look for cortisol levels in blood.

  • Late Night Measurements of Cortisol in saliva

    : Cortisol is measuled by taking a sample of saliva late in the night.

  • Sampling Cortisol in saliva for a 24 hour period

    : This test is recently cleared by the FDA and is equally effective as the above. Saliva samples are taken every couple of hours and checked for cortisol.

  • Dexamethasone Suppression Test

    : The patient is given a low dose of a synthetic steroid or glucocorticosteroid to look for ACTH and cortisol levels so that it can be linked to any steroid medication that the patient may be taking.

Whenever an individual tests positive for any of the above tests, the following tests are further conducted to check whether any pituitary tumor is behind it at all.

  • Computed Topography Scanning (CT Scanning).
  • Magnetic Resonance Imaging (MRI).
  • Petrosal Sinus Sampling.

Treatment of Cushings Syndrome

The good news is that on treatment, the syndrome can be cured and the extra fat deposits may disappear. The different treatment options of the disease are as follows:

  • Surgical removal of tumors

    : The pituitary tumors causing the excess secretion of cortisol and ACTH have to be removed surgically in a procedure known as the Transsphenoidal Adenomectomy, conducted with the help of a special microscope.

  • Medication

    : Medications are also often used to treat the excess cortisol in blood whenever surgery is not recommended.

  • Stopping Medications

    : If the condition is induced from medications which are glucocorticocoids, then the drug needs to be stopped and other options should be explored.

  • Radiation and Chemotherapy

    : Radiation and chemotherapy are used when the disease develops in association with cancer.

It is extremely important to be informed of clinical conditions which could cause obesity. Besides, it is imperative to eat proper nutritious meals and engage in regular exercise along with any therapy or treatment.

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