Overview of typical symptoms
- Truncal obesity
- Moon Face
- Poor healing of skin defects
- Muscle loss (thin arms and legs compared to healthy people of the same age)
- Skin changes (thin parchment skin and tendency to bruising)
- Psychological changes (from mood swings to depression, in children often: aggressive behaviour)
- Clouding of the eye lens (cataract)
- Osteoporosis
- Weight gain
- Increased susceptibility to infections
Often patients with Cushing’s syndrome suffer from osteoporosis at a young age and complain of bone pain. Similarly, muscle weakness and muscle pain are common symptoms of Cushing’s syndrome. The patients feel powerless and lacking in drive.
The following signs of the disease can be seen on the skin: Wound healing in injuries is poor and the skin thins, which can be seen especially on the back of the hand. The patients also have red stretch marks on the skin (striae). Patients with hypercortisolism (too much cortisol) often develop diabetes (diabetes mellitus), as cortisol causes the release of sugar into the bloodstream, which can lead to high blood sugar levels.
Cushing’s patients have high blood pressure in 85% of cases. The development of depression is a not uncommon symptom in Cushing’s syndrome. Changes in the blood count can also be observed in Cushing’s syndrome: The platelet and red blood cell counts and total white blood cell count are elevated, while for special forms of white blood cells, eosinophils and lymphocytes, the counts are lower.
In women, Cushing’s syndrome can lead to symptoms such as menstrual disorders and acne formation. It can also lead to masculinisation (androgenisation). In 80% of cases, men with Cushing’s syndrome have erectile dysfunction and both sexes lose their libido. When children are affected by Cushing’s syndrome, growth disturbances and a delay in development occur.
Severe weight gain with “trunk obesity
The strong weight gain under a therapy with glucocorticoids is not necessarily only due to an increased accumulation of fatty tissue. The apparent weight gain is mainly explained by the optical changes in the body caused by the glucocorticoids. This is because cortisone increases fat loss in the extremities in a purely selective manner.
In addition, it provides for an increased breakdown of proteins, which manifests itself in muscle atrophy. As a result, the volume of arms and legs decreases, whereas the upper body often subjectively appears thicker than before to those affected. A “trunk fat addiction” is therefore suggested.
However, it is not necessarily increased fat that accumulates on the chest, stomach and back. Rather, it is a water retention in the tissue, which feigns an increase. This is due to the additional effect of glucocorticoids on the electrolyte balance. An increased fat accumulation is only found in a longer existing Cushing’s syndrome by an additional influence on the sugar metabolism.
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