What is it?

Hormones are special chemicals which are produced then travel all over the body in the blood to do their work.

The Adrenals (Latin for ‘Near the Kidney’) normally produce a hormone called Cortisol (also called Hydrocortisone).

Cortisol is essential for life and health, but too much of it can be very harmful.

When the adrenal glands become overactive, the normal healthy control of Cortisol breaks down. When too much Cortisol is produced, Cushings is the result.

There are several forms of Cushings, each with it’s own particular treatment.

a) Pituitary Cushings. This is the most common and accounts for around 60% of all cases of Cushings. As its name suggests, the problem lays in the pituitary gland, a small gland below the brain, just behind the nose.

This pea-sized chemical factory does many jobs for the body, one of which is the control of the amount of Cortisol the adrenal glands make.

It does this by producing another hormone called ACTH, which tells the adrenals how much Cortisol to produce.

Pituitary Cushings is usually caused by a tumour (‘Lump’) on the pituitary gland, which upsets the gland and increases the amount of ACTH being sent to the adrenals.

This increase in ACTH results in an increase of Cortisol around the body and the condition known as Cushings.

b)  In other cases the increase in ACTH can be the result of tumours elsewhere in the body, which have ‘learned’ to produce their own ACTH. This will have the same effect on the body, but the treatment will be different.

Why do i feel this way?

The symptoms you will have noticed are nearly all due to having too much cortisol around your body.

Most people with Cushings find the symptoms come on slowly, and are not so noticeable. People who are overweight or who have high blood pressure will not have Cushings, but many of the things they experience will be the same. It is only when a lot of these symptoms all happen together that alarm bells start ringing.

Here are some of the most common symptoms associated with the condition:

Weight increase, particularly around the torso. Most noticeable on the stomach, neck and top of back and conspicuously absent on the arms and legs. You look a bit like a cushion, which may be one of the origins of the name of the condition (not really!).
stretch marks on the stomach.
Rounding and reddening of the face.
High blood pressure
Mood swings, depression, panic attacks, forgetfulness – the brain just doesn’t seem to be working properly.
Sleepless nights, sleepy periods during the day.
Weakness or even wasting of the muscles of the legs, torso and shoulders.
Backache. Difficulty standing up or climbing stairs.
Swelling of the feet.
Bruising for no reason, especially the legs and arms.
Headaches and dizziness.
A mild form of diabetes.
Skin infections, skin thinning and sometimes even tearing.
Facial and body spots.
Women find that their periods become irregular or stop altogether.
Hair growing on the face or body, while losing it on the scalp.
Sex drive is reduced.
Thinning of the bones of the spine, hips or ribs(osteoporosis).
Change in body odours, feet and underarm.
A need to drink fluid, always thirsty
Breathlessness
Peripheral vision – there may be diminished field of vision.
Backaches, particularly in the lower back.

What is diabetes insipidus?

Some time during your period of tests you may hear the word diabetes insipidus. This is a ‘water’ diabetes, and not the ‘sugar’ diabetes most people are aware of (diabetes mellitus)

Diabetes insipidus means the kidneys are unable to retain water and large volumes of urine will be produced. This will cause you to feel very dry and thirsty.

In diabetes insipidus there is no problem with sugar in the blood or urine. There is, however, the lack of a water-retaining hormone in the blood (called vasopressin) or sometimes an abnormality in the kidneys which prevent them responding to the hormone. Vasopressin is one of the hormones produced by the pituitary gland. This most often happens after surgery.

Further information can be obtained from:
The Pituitary Foundation
17/18 The Courtyard
Woodlands
Almondsbury
Bristol
BS12 4NQ.

What can i do for myself?

Keep optimistic. Sounds easy, but do try.
Let family and friends help
Admit that you have good and bad days.
Rest when your body tells you.
Listen to the doctors, make notes, ask questions and write down the answers.
Remember that you do not look as ill on the outside as you feel on the inside.
While you are waiting for tests, results or an appointment with an Endocrinologist, keep a diary of your mental and physical well-being. It is easier than trying to remember your symptoms.
Take a list of questions with you, and don’t be afraid of the answers. The truth is always an easier pill to swallow. Your imagination is probably far worse.
If you are still smoking, now is a good time to STOP. Calcium tablets and high-calcium foods have no effect – they are not absorbed at all.

Diet

What can you do with your diet? Well first of all look at what you are eating.

Cushings causes a breakdown of proteins, reduces the calcium and increases the fat layers around the body. What can you do?

Calcium tablets and high calcium foods have no effect – they are not absorbed at all.

Extra protein intake will be broken down with the body seeing very little benefit of it.


Our only advice is:

Cut down on fatty foods.

Eat a good healthy diet – pasta, rice, wholemeal bread, vegetables, fruit (lots of bananas (Potassium), citrus fruits, grapefruit, pineapple, etc), eggs, lean meats, half-fat cheese.
Reduce your intake of fats and salts.

Cut down on tea and coffee. Try fruit or herb teas that give you a sense of well-being. Drink fruit juices and water.

Only eat as much as you really want, not just for the sake of it. Try two or three small meals a day. Many patients find that highly spiced foods also make them feel ill.


Exercise

What? How can we even suggest such a thing when you’re not feeling well? In fact, gentle exercise will increase your sense of well-being. Try Some of these:

Swimming.
Aqua aerobics.

Both the above involve water, which will support much of the body weight and ease pressure on weakened limbs. There is also an element of fun if friends are involved.

Walking.
A gentle stroll helps the muscles, and a friend to talk to will give you something to take your mind off what you may be going through.

Cycling.
This is good for the limbs, but remember your limitations and avoid too many hills if you are not up to it. The Tour de France will wait until you are better.

Whatever you do, don’t sit around and give up. Rest, but don’t become static.


Information Courtesy of:
Association for Cushing’s Treatment and Help

Coordinator: Miss Elaine Eldridge
Telephone: 01628 670389
Fax: 01628 415603
Email: cushingsacth@btinternet.com

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