Moon face, buffalo hump? What is this disease that causes a sudden drop in appearance?

Review expert: Wu Xi, deputy chief physician, Department of Endocrinology, Huashan Hospital, Fudan University, doctor of medicine

Some time ago, Ms. Zhao from Shaanxi found that she had become uglier and uglier in the past year. Her face was covered with acne. Her appetite did not increase, but her waistline became thicker and her limbs became thinner. Her menstruation was irregular and she even had amenorrhea. She went to the hospital and found that she had an endocrine disease, Cushing's syndrome .

Often we see in the news that babies who have applied creams or ointments containing hormones have swollen faces and edema bodies. This is also due to the misuse of hormones and they have developed Cushing's syndrome.

Source: Weibo screenshot

Cushing's syndrome was first described by Harvey Cushing, a famous American neurosurgeon in 1912.

Although most people think that Cushing's syndrome is a rare disease, new data show that Cushing's syndrome is more common than previously thought, and that it occurs more frequently in women than in men. Cushing's syndrome not only has strange clinical symptoms, but it can also be life-threatening. So you must be curious about what causes this strange disease and what symptoms it has?

What are the symptoms of Cushing's syndrome?

Cushing's syndrome (CS), also known as hypercortisolism, is a series of clinical syndromes caused by elevated cortisol levels in the blood and long-term excessive secretion of glucocorticoids by the adrenal cortex.
Long-term excessive secretion of blood cortisol can cause corresponding clinical manifestations, such as central obesity, edema, hypertension, hirsutism, mental abnormalities, thinning skin, menstrual disorders, kidney stones, bone loss or fractures, etc.
However, the probability of these symptoms occurring in patients with different causes is different. Not every patient with Cushing's syndrome has obvious clinical manifestations. Some early cases only show high blood pressure and are in good physical condition. Some patients do not even have any clinical symptoms.

Cortisol molecular structure source: Wikipedia

Obesity is one of the main symptoms of Cushing's syndrome. Central obesity occurs in more than 70% of patients. Patients will find that they are gaining weight without changing their diet, and the fat begins to redistribute on the face, back, waist and abdomen. Moon face and buffalo hump will appear. This is because excessive cortisol will cause the decomposition of muscles, bones and skin, leading to increased blood sugar and increased insulin secretion. Insulin activates lipoprotein lipase in the fat cells around the waist and abdomen - an enzyme that helps fat cells accumulate more fat molecules, leading to central obesity. This may also be the reason why some people cannot lose weight.

Osteoporosis is a common complication of Cushing's syndrome. The main cause of osteoporosis is impaired bone formation and increased bone resorption. Cushing's syndrome patients have insufficient vitamin D in their bodies, which leads to reduced muscle mass and affects calcium absorption, causing osteoporosis. At present, the mechanism by which cortisol affects vitamin D levels is still unclear and needs further study.

Abnormal cortisol levels in patients with Cushing's syndrome will also affect gonadal function, inhibit the secretion of gonadotropin-releasing hormone in the hypothalamus, and lead to ovarian and testicular dysfunction. Female patients will have characteristics such as beards and abundant body hair, while male patients will show sexual dysfunction.

Finally, too much cortisol can also lead to high blood sugar levels, and high blood sugar levels may develop into diabetes.

What causes Cushing's syndrome?

The causes of Cushing's syndrome are mostly ACTH-dependent bilateral adrenal hyperplasia, or adrenal cortical adenoma, cortical adenocarcinoma, ectopic ATCH syndrome, and Cushing's syndrome-like syndrome caused by long-term exposure to glucocorticoids and excessive drinking.

Cushing's syndrome can be caused by exogenous cortisol, usually caused by improper medication use. Most patients take steroids for a long time to treat immune or inflammatory diseases, such as asthma. The molecular structure of steroid drugs is very similar to cortisol, so they can mimic the function of cortisol in tissues.

Cushing's syndrome can also be caused endogenously - that is, elevated levels of cortisol produced by the body. The most common cause is excessive levels of ACTH (adrenocorticotropic hormone) in the body, and pituitary adenomas are the main cause of this hormone disorder. This is a benign tumor and is generally called Cushing's disease.

Excessive ACTH stimulates the zona fasciculata of the adrenal glands, causing them to enlarge and secrete cortisol. Another cause of endogenous Cushing's syndrome is an adrenal tumor that causes excessive cortisol secretion. 80% of adrenal adenomas occur in women of childbearing age.

Diagnosis and treatment of Cushing's syndrome

Cushing's syndrome has a variety of clinical manifestations, complex causes, and lacks diagnostic hormone indicators. Clinical diagnosis is very difficult and can easily lead to missed or misdiagnosis. Therefore, early detection and diagnosis are very important. For example, Cushing's syndrome may be misdiagnosed as a mental illness such as bipolar disorder, because the cortisol receptors in the brain control a person's memory and emotions, and abnormal cortisol levels can cause anxiety, depression, mania, etc., leading to misdiagnosis.

Generally, the diagnosis of Cushing's syndrome is based on the measurement of free cortisol in a 24-hour urine sample, which is convenient for calculating the total amount of urinary cortisol excreted from the body within 24 hours. Another method is the dexamethasone suppression test, which gives the patient a low dose of dexamethasone , a steroid that inhibits ACTH production in the pituitary gland. If Cushing's syndrome is caused by excessive endogenous cortisol production, then serum cortisol levels should not be suppressed by low doses of dexamethasone.

Dexamethasone ball-and-stick model Source: Wikipedia

The treatment of Cushing's syndrome also depends on the cause. If it is caused by exogenous drugs, then the dosage of the pathogenic drug should be gradually reduced, and the drug should not be stopped suddenly, otherwise it will cause rebound. If it is caused by a pituitary adenoma, such as Cushing's disease, surgery may be required to remove the adenoma.

In life, we should also pay attention to taking medicine according to the doctor's orders when we are sick, and strictly follow the dosage, frequency, and time of use required by the doctor to avoid side effects as much as possible. Do not buy and take medicines on your own to avoid excessive intake of steroids. When parents choose products such as face creams and body lotions for their children, they should also pay attention to the ingredients. If there are strong hormone ingredients such as fluticasone propionate, fluticasone acetate, clobetasol propionate, etc. , they should be selected with caution to avoid affecting the health of their children.

In addition, we should maintain good living habits and a good attitude. Even if we are unfortunately sick, we don’t have to worry too much. Early diagnosis of the disease and timely treatment are crucial. At present, both the equipment and technology have the conditions to treat the disease. As long as we actively cooperate with the doctor’s treatment, we may be able to recover.