Sometime last year Priya Bhatia, a 31-year-old entrepreneur based in Bengaluru, suddenly noticed extra facial hair and consistent acne. She also did not menstruate for six months. Her test results indicated pituitary microadenoma — a non-cancerous tumour in the pituitary gland that can lead to weight gain, excessive hair growth, inflammation and affect the body metabolism. This, in turn, can lead to Cushing disease in women. Bhatia’s cortisol values too were very high — a clear sign of the condition.
Cushing disease is an endocrine disorder that results in hypercortisolaemia (excess cortisol hormone in the body). This is caused by chronic, excessive and inappropriate exposure to glucocorticoid (GC). The GC exposure can be due to external or internal factors. Cortisol is a stress hormone that regulates the body’s metabolism and higher cortisol can lead to insulin resistance.
Experts have found that hypersecretion of GCs can adversely impact the metabolism. It could lead to insulin resistance, visceral adiposity (excess fat in the abdomen) and muscle atrophy (thinning of muscle tissue).
Women at risk for Cushing disease: why?
“The incidences of Cushing disease are more in women,” Dr N Sapna Lulla, from Aster CMI Hospital, Bengaluru, who has 23 years of experience as an obstetrician, gynaecologist and infertility specialist, tells Happiest Health. “It is five times more common in females than males; however, a pathophysiological explanation for the same is lacking. Women in the age group of 30 to 50 are largely at risk of developing Cushing disease.”
According to various studies, the Cushing disease caused by internal factors is more common in women than men.
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Cushing disease: Warning signs and symptoms
Cushing’ syndrome is specifically caused by ACTH (adrenocorticotropin hormone) secreting pituitary adenoma. “If serum cortisol levels are more than 36 ug/ml, then the doctor can take a call to investigate if a person is having Cushing’s syndrome,” says Dr Lulla. The other signs include any of the following:
- repeated infections or sepsis
- irregular cycles
- sudden weight gain
- increased blood pressure
- thick facial hair
- absent menstrual period
In a 2006 research paper, endocrinologists Dr John Newell-Price, Dr Xavier Bertagna, Dr Ashley B Grossman and Dr Lynnette K Nieman specifies some other clinical features of Cushing’s syndrome:
- Facial plethora (swelling and redness of the face); rounded face
- Decreased libido
- Thin skin
- Decrease linear growth in children
- Depression/emotional lability
- Easy bruising
- Glucose intolerance
According to Dr Lulla, Cushing’s syndrome is associated with the following comorbidities:
- Dyslipidemia (lipid imbalance in the body)
- Osteoporosis
- Nephrolithiasis or kidney stones
- Cardiovascular diseases
- Diabetes
- Atherosclerosis (excess fat deposition in the artery walls and increased cholesterol levels)
Causes of cushing disease
“Pituitary adenoids account for 60 to 70 per cent of these cases,” Dr Lulla says. “Most often, the underlying cause is a stagnant lifestyle, increased stress, increased blood sugar levels and exaggerated response to situations. These affect women three times more than men.”
Diagnosis
Studies suggest that Cushing disease can be optimally screened through tests such as:
- low-dose dexamethasone-suppression tests
- up to three 24-hour urinary free cortisol samples
- late-night salivary cortisol
- midnight serum cortisol
Treatment
Treatment should include a holistic approach involving medications for treating the specific symptoms as well as food and lifestyle modifications.
Adopt a low-calorie and anti-inflammatory diet
“The treatment strategy is always case specific and individualised,” dietician Soumya S Nair, who works in ESIC Hospital, Ezhukone, Kollam, Kerala, tells Happiest Health. “Diet modification can largely help in correcting weight gain and other issues associated with Cushing’s syndrome. The syndrome is generally accompanied by a host of comorbidities. A good treatment plan should treat the symptoms.”
Nair says since people with Cushing’s syndrome may have comorbidities such as diabetes or hypertension, the recommended diet should count these factors too. “Diet that is anti-inflammatory and low-fat is highly beneficial,” she says. “Omega-3 fatty acids have anti-inflammatory properties. These are present in vegetables such as spinach, walnuts, flaxseeds, mackerel, cod liver oil, sardines, lean protein such as salmon, Greek yoghurt, tofu, tempeh, eggs, lentils and beans.
“We need good fat — hence a handful of nuts is advised. Sometimes, adding ginger and garlic to the diet might help reduce inflammation; so does green tea. Foods rich in Omega-3, such as lean protein, also help. These could also include fish, plain yogurt, lentils and the like. Mediterranean diet falls in the anti-inflammatory diet criteria. The key lies in practising moderation in every meal.”
Food to avoid
Nair recommends the following should be avoided to reduce Cushing’s syndrome:
- industry-processed or artificially flavoured food
- spicy or hot food foods
- food rich in glycaemic index (sugar, sodium, rice, processed grains)
- fizzy drinks such as soda, colas
Reverse sedentary lifestyle
“Cortisol is not our enemy,” says Dr Lulla. “However, being active, reducing our stress levels, increasing the exercise threshold, getting enough rest, trying to slow down and monitoring cortisol levels when on certain medications can help control cortisol levels.”
It is advised to practice anaerobic exercises — such as stretches — that are slow and not strenuous. These help to relax the muscles, mind and body. Alternative therapies such as yoga and Tai Chi can be highly beneficial.
Calcium checks: Since corticosteroid may delay calcium absorption, it is important to assess calcium levels and take calcium tablets based on expert recommendation.
(Inputs by Dr Vishnupriya B)
