"Cushingoid" is a term that refers to those signs and symptoms that resemble those of Cushing's disease or Cushing's syndrome. Both Cushing's syndrome and Cushing's disease occur for the same reason: too much glucocorticoid hormone (cortisol) in the body. If the reason for the abnormally high level is due to a tumor in the pituitary gland, the symptoms are referred to as Cushing's disease. If the symptoms arise for any other reason--most commonly, chronic use of glucocorticoid medication--the symptoms are called Cushing's syndrome.
Obesity
This is the most common Cushingoid symptom, and it is not simply weight gain. In up to 90 percent of patients, the fat of the body redistributes and tends to settle in the abdominal area, a type of obesity called central obesity. Another very common phenomenon is "moon face." The face becomes round because of fat deposition. Similarly, fat deposits around the shoulder blades and back of the neck give rise to a "buffalo hump" on the upper back of the Cushingoid patient.
Skin Changes
A variety of skin changes are common in patients with Cushingoid symptoms. Skin thinning, easy bruising and stripes called striae may occur. The latter are typically reddish purple, wide stripes that occur on the abdomen; they develop because the connective tissue just under the skin is decreased in people with Cushingoid symptoms. Another skin-related symptom is facial plethora, in which the face develops a reddish color.
High Blood Pressure
Hypertension (high blood pressure) is one of the hallmark signs of Cushing's syndrome and is present in over 75 percent of cases. The exact cause is not yet known.
Hairiness
The great majority of female patients with Cushing's syndrome (80 percent) will notice more growth of facial hair as well as more hair over the abdomen, chest and upper legs. This is because male sex hormones (androgens) that cause hair growth in men are being produced within the body.
Muscle Weakness
Because excess cortisol is associated with specific muscle-related changes (low total body protein and decreased muscle mass), some patients may experience muscle weakness. Most commonly it occurs in the upper leg and thigh regions.
Diabetes
Because cortisol acts in opposition to insulin, it makes the insulin that the body produces much less effective. Without effective insulin, the body is not able to use sugar correctly; diabetes may develop in up to 80 percent of cases.
Osteopenia and Osteoporosis
Glucocorticoids have significant and long-lasting effects on the bones. Patients who have been exposed to high levels of cortisol for a period of months or years will likely develop either osteopenia (decreased bone density) or osteoporosis (bone density that is decreased well below a certain level). In children, the decrease in bone formation, in combination with a decrease in the production of growth hormone, may result in growth retardation. In either children or adults, frequent bone fractures may occur. Patients may complain of back pain that is due to small fractures of the spine.
Vulnerability to Infection
Excess cortisol changes the body's normal immune response; fewer immune system cells are circulating. A person with Cushing's syndrome will find himself more prone to infections and may also notice that wounds take a longer than usual to heal.
Sex-Organ Dysfunction
Sex-related abnormalities also occur when there is too much cortisol in the body. In women, excess androgens, or male sex hormones, are produced, so they may have irregular or no periods, acne, and unusual hairiness. In men, less testosterone is produced, resulting in impotence, loss of body hair, small testes and decreased sex drive.
Psychological Disturbances
In about 80 percent of cases, patients with Cushingoid symptoms will have some psychological symptoms. They may be mild, such as feeling more irritable or emotional than usual. Some patients may experience more debilitating symptoms, such as anxiety, memory lapses, euphoria and insomnia. On the more severe end of the psychological spectrum, patients may suffer from psychosis (perhaps with hallucinations), paranoia or severe depression.
References
- "Greenspan's Basic & Clinical Endocrinology"; David Gardner and Dolores Shoback; 2007
- "Pathophysiology of Disease: An Introduction to Clinical Medicine"; Stephen J. McPhee and Gary D. Hammer; 2009
- "Current Medical Diagnosis and Treatment"; Stephen J. McPhee and Maxine A. Papadakis; 2010
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