Full moon face usually develops in the context of body fat redistribution due to hormonal causes. It is a typical leading symptom in medicine. As a rule, it occurs together with other characteristic symptoms.
What is a full moon face?
A full moon face occurs mainly in the context of Cushing’s syndrome, which is due to elevated cortisol levels in the blood. When a full moon face occurs, it must usually be assumed that there is a pathological redistribution of fat in the body. However, it is not an independent disease, but a characteristic leading symptom of various hormone-related disorders in the organism. It is manifested by a roundish facial shape with reddened cheeks. Furthermore, it is characterized by a slanting of the eyes, a so-called carp mouth and a double chin. It occurs mainly in the context of a Cushing’s syndrome, which is based on an increased cortisol level in the blood. However, a full moon face can also develop in extreme forms of obesity (adiposity) and Pickwick syndrome. It often develops as a side effect of drug treatment for rheumatic diseases, allergies or autoimmune diseases. The development of a full moon face should always be used as an opportunity to consult a physician for clarification of the cause.
Causes
Full moon face typically occurs in a condition called Cushing’s syndrome. This syndrome is caused by increased levels of the stress hormone cortisol in the blood. This results in the redistribution of body fat with the formation of truncal obesity with bull neck and full moon face. Cortisol has the task of quickly supplying the organism with energy under stressful situations. In doing so, it mobilizes the existing body reserves in the liver (glucogen) and muscles (protein breakdown). It initiates the conversion of glucogen and amino acids into glucose. As a result, blood glucose levels rise. As a result, the production of insulin is stimulated, which carries the glucose into the cells for energy. Unfortunately, in Cushing’s syndrome, it is not an increased glucose requirement that is responsible for the increase in cortisol levels, but rather the pathological overproduction or additional administration of cortisol as part of drug treatment. The body’s energy requirement has therefore not increased. Thus, the released glucose is stored as fat. Cortisol thus breaks down muscle mass and converts it into fat. At the same time, bone density also decreases. Since cortisol also has an immunosuppressive effect, the immune system is additionally weakened. However, when allergies, rheumatism and other autoimmune diseases are treated with drugs containing cortisone, this is precisely what is supposed to be achieved, in order to weaken the immune system‘s excessive reaction against parts of its own body. Other causes of full moon face may include extreme forms of obesity such as Fröhlich syndrome.
Diseases with this symptom
- Cushing’s syndrome
- Autoimmune disease
- Obesity
- Rheumatism
- Fröhlich syndrome
- Pickwick syndrome
Symptoms, complaints and signs
As already mentioned, increased cortisol concentrations in the blood cause the so-called Cushing’s syndrome with a full moon face as a typical leading symptom. In this case, the same characteristic clinical picture is seen regardless of the cause of the elevated hormone levels. The patient thus suffers from truncal obesity with bull neck and full moon face. Furthermore, infections occur frequently due to the weakened immune system. Bones and muscles are degraded. This can lead to osteoporosis and muscle atrophy. The connective tissue is also affected. So-called striae rubrae, stretch marks, form. These are red skin stripes that result from the tearing of the connective tissue. High blood pressure is also a typical symptom of Cushing’s syndrome. Furthermore, virilism (masculinization) can occur in women and potency disorders in men. Depending on the cause of the elevated cortisol levels, a distinction is made between exogenous and endogenous Cushing’s syndrome. The more common exogenous Cushing’s syndrome is the result of therapies with cortisol-containing drugs for allergies, rheumatic diseases and autoimmune disorders. The rarer endogenous Cushing’s syndrome is caused by hyperfunction of the adrenal glands or the pituitary gland.The adrenal glands produce cortisol directly, while the pituitary gland stimulates cortisol synthesis in the adrenal glands via its hormone ACTH. Both benign and malignant tumors can cause overproduction of the hormones.
Diagnosis and progression
To diagnose the exact causes of full moon face, the physician first examines urine samples to determine whether elevated cortisol concentrations are present. If so, in the case of endogenous Cushing’s syndrome, a dexamethasone inhibition test and a CRH test must be used to clarify at which point the regulatory circuit is disturbed. Imaging techniques such as CT, ultrasound, or MRI can detect any tumors on the adrenal glands or pituitary gland.
Complications
A full moon face is a sign of Cushing’s syndrome, which carries many different complications. First, increased cortisol levels result in increased brittleness of the bones (osteoporosis). This severely limits the quality of life, sufferers have to be careful and usually become in need of care as the condition progresses. This can lead to severe psychological problems, especially depression. The depression can be characterized by strong addictive behavior. In addition, sleep and eating disorders also occur. It is not uncommon for the chronically depressed person to have suicidal thoughts. Furthermore, the immune system of the affected person is suppressed and he or she is more prone to infections. In the worst case, these can spread and lead to sepsis, which can then end in septic shock. This condition is life-threatening and, if left untreated, leads to death in more than half of those affected. The increased reabsorption of water also usually results in high blood pressure (hypertension) in the affected person. This increases the risk of cardiovascular disease and the development of atherosclerosis. Cushing’s patients also usually develop diabetes. Through this, smaller vessels become clogged and lead to a lack of blood flow, especially to the kidneys and eyes, which can eventually lead to kidney weakness or visual impairment, respectively, and even kidney failure or blindness.
When should you go to the doctor?
Moon face may well run in families. It does not necessarily have to have a disease value. However, it is also known that people develop a full moon face after prolonged treatment with cortisone. This can be reversed in the medium term by a change in diet. The increased appetite due to the cortisone can be effectively undermined by nutritional counseling. Cushing’s syndrome can also lead to a full moon face. An overproduction of adrenal cortical hormones can be determined as the cause by the physician consulted. If this disease or hypercortisolism is suspected, it must be determined whether it is a possible consequence of prolonged cortisone administration or the effects of a (benign) tumor. This may have formed in the adrenal cortex, the pituitary gland or the bronchi. In addition to the full moon face, the attending physician usually notices an increase in weight on the upper body. He can also conclude that Cushing’s syndrome is present on the basis of other typical features. Through various examinations such as a 24-hour urine check, the cause of the full moon face can be determined. After that, either a referral to a hospital for surgery or radiation of a tumor is made, or a drug treatment is conceivable. Alternatively, an attempt is made to lower the cortisol concentration in the blood. If a full moon face occurs repeatedly, permanent medical monitoring is necessary.
Treatment and therapy
Treatment of full moon face depends on the particular cause. If there is an increased cortisol concentration due to the intake of cortisol-containing medications, their application must be gradually reduced if the Cushing’s syndrome is massive. However, the drugs must not be discontinued abruptly, because the hormonal control circuit would not react immediately. Their discontinuation must be gradual. If the high cortisol level has endogenous causes, surgical intervention on the adrenal glands or the pituitary gland may be necessary if a tumor is present. If this is not possible, radiation or chemotherapy may be considered. Drug treatments to inhibit cortisol formation may also be used for certain forms of Cushing’s syndrome.After normalization of cortisol levels, the symptoms of Cushing’s syndrome including full moon face disappear very quickly.
Outlook and prognosis
In itself, full moon face is harmless. This is especially true if it is present for hereditary reasons or is due to severe obesity. A full moon face does not have to have a disease value. In the case of severe overweight, it is to be regarded as a consequence of increasing adiposity. In this case, clinically supervised diets or stomach reduction over a longer period of time can ensure that the obese patient acquires a better prognosis. However, if the full moon face is Cushing’s syndrome, the outlook is worse. This is a hormonally induced full moon face. This is related to increased cortisol production. In this rarely occurring disease, the full moon face can be a symptom of disorders of the adrenal glands or problems with the pituitary gland. It is often the result of a benign tumor of the pituitary gland called an adenoma. The prognosis for full moon face is quite good if the underlying disease or disorder is treated properly. Full moon face can also occur if medications containing cortisone are administered over a long period of time. This may be necessary, for example, in the case of a chronic inflammatory bowel disease or bronchial asthma. A Cushing’s syndrome with full moon face can then occur as a side effect. This disappears again as soon as the medication is discontinued. Overall, the prognosis is good with appropriate treatment.
Prevention
Prevention is only possible against full moon face in the context of extreme obesity. Hormone-independent obesity can be prevented by a healthy diet and adequate physical activity. However, Cushing’s syndrome is not preventable even by prevention. However, when cortisol-containing drugs are administered, constant monitoring of the patient should take place. If symptoms such as truncal obesity with full moon face and bull neck and frequent infections occur during drug use, adjustment of drug treatment is urgent.
What you can do yourself
A so-called full moon face can occur in the context of various diseases. Characteristics are a round, reddened face, often also bloated, bluish discolored cheeks, slanted eyes and a double chin. The mouth is also deformed, and hirsutism often occurs in women in this context. In addition to medical treatment, those affected can do a number of things themselves to alleviate their suffering. One conceivable option is cosmetic treatments such as make-up, although patients should seek advice from professional cosmeticians regarding their particular problem. The right haircut can also somewhat mitigate visual disturbing factors, as it can make the face appear narrower or even conceal it in places. Excessive hair growth in women can also be treated cosmetically, e.g. by laser therapy, epilation, waxing or plucking). Even if the facial and body deformities that occur as part of the conditions that bring on a full moon face are medically based, regular, targeted exercise can mitigate the worst manifestations. This is especially true when obesity is the cause. The same is the case if a certain medication is the cause. In the latter case, it would also have to be considered whether the preparations should not be changed. Exercise can also help to curb the production of the stress hormone cortisol, which also has a beneficial effect on fat distribution in the body.
