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What Is Cushing Syndrome?

High Levels Of Cortisol In Your Body Can Result In Cushing Syndrome. Left Untreated, Cushing Syndrome Can Cause Distressing Sy...
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What Is Cushing Syndrome?
~5.5 mins read
Illustration of a semicircular meter with sections going from green to yellow to orange to red, with the word cortisol above it, low at the bottom left corner and high at the bottom right corner, and a silver arrow in the center pointing toward the high end.
High levels of cortisol in your body can result in Cushing syndrome. Left untreated, Cushing syndrome can cause distressing symptoms and lead to serious health complications. Fortunately, tests can help determine the cause of high cortisol levels, which can guide treatment

What is Cushing syndrome?

Cushing syndrome, also known as hypercortisolism, occurs when you have higher-than-normal levels of cortisol in your body for a significant duration of time. Cortisol is a hormone made by your adrenal glands, two small glands located next to the kidneys. You can have high levels of cortisol if your adrenal glands overproduce it, or if you take cortisol-like medications (glucocorticoids) at high doses for a long time to treat another condition. The high cortisol levels can cause various symptoms and possible health complications.
In normal amounts, cortisol helps your body maintain blood pressure and blood sugar level, reduce inflammation, and regulate salt balance, among other functions. Cortisol is also directly connected to the body's stress response. Your body releases cortisol to help you deal with stressful situations.
Cushing syndrome due to your own body making too much cortisol (rather than taking too much) affects about three times as many women as men, and is most common in people ages 20 to 50. Cushing syndrome is considered rare, but the actual number of people who have it is unknown since some go undiagnosed.
"In Cushing syndrome, there are clinical signs that indicate your body has too much cortisol," explained Dr. Lisa Nachtigall, clinical director of the Neuroendocrine & Pituitary Tumor Clinical Center at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School. "Once high cortisol levels are established, the next step is to figure out why that is happening."

What can cause Cushing syndrome?

The most common cause of Cushing syndrome is long-term use of glucocorticoids. Glucocorticoids are steroids used to treat a variety of conditions including asthma, cancer, inflammatory bowel disease, lupus, joint pain, and rheumatoid arthritis. They are also used to prevent transplant rejection. Examples of glucocorticoids are cortisone, prednisone, dexamethasone, and prednisolone.
Less often, Cushing syndrome occurs when the body makes too much cortisol. This is usually caused by a tumor (typically noncancerous) in the pituitary gland. Located at the base of your brain, the pituitary gland produces a hormone called adrenocorticotropic hormone (ACTH) that normally instructs the adrenal glands to make cortisol. A tumor can spur the pituitary gland to produce too much ACTH, which in turn causes the adrenal glands to produce too much cortisol. This form of Cushing syndrome is called Cushing disease.
In other cases, tumors in other organs can produce ACTH and lead to Cushing syndrome. Finally, the adrenal glands themselves can develop tumors that overproduce cortisol and can lead to Cushing syndrome.

Symptoms of Cushing syndrome

Symptoms of Cushing syndrome include:
  • weight gain, especially around the abdomen
  • rounded face, sometimes called Cushing syndrome moon face
  • a fat pad on the back of the neck
  • purple or red stretch marks, usually around the abdomen, chest, and underarms
  • easy bruising
  • high blood pressure (hypertension)
  • high blood sugar and diabetes
  • muscle weakness
  • thinning bones (osteoporosis)
  • depression and problems with thinking
  • too much facial hair in women (hirsutism)
  • erectile dysfunction (ED) in men.
    • Left untreated, Cushing syndrome increases the risk of hypertension, diabetes, skeletal fractures, blood clots, heart attack, stroke, and increased risk of infections.

    Diagnosing Cushing syndrome

    Because symptoms of Cushing syndrome can mimic many other conditions, diagnosis can be challenging.
    Dr. Nachtigall points out that many people have symptoms of Cushing syndrome for years before they are diagnosed. "Unfortunately, Cushing syndrome isn't easy to diagnose," she says, "which can be very frustrating and overwhelming for patients."
    Diagnosing Cushing syndrome is usually straightforward in people who are taking glucocorticoids. For others, tests used for diagnosis include:
  • Dexamethasone suppression test (DST). You take a low dose of the glucocorticoid dexamethasone at night and have your blood drawn in the morning. Cortisol levels normally drop after taking dexamethasone, so high levels are a sign of Cushing syndrome.
  • 24-hour urinary free-cortisol test. You collect your urine over 24 hours and have it analyzed in a lab. According to Dr. Nachtigall, this test is better than DST but is less sensitive early in the course of Cushing syndrome.
  • Salivary test. This measures the level of cortisol in your saliva late at night, when normal cortisol production should decrease. You collect your saliva at home at your usual bedtime and have it sent to a lab for testing.
    • Once your doctor diagnoses Cushing syndrome, the next step it to determine why it has happened. Knowing the cause of high cortisol levels guides the treatment.
    If you take glucocorticoid medication, that's likely the cause of your Cushing syndrome. If Cushing syndrome is caused by the body's overproduction of cortisol, and after the high levels of cortisol have been definitively confirmed, the following tests can help pinpoint the specific reason:
  • blood tests to measure levels of the hormone ACTH in your body (this indicates whether a tumor is in your pituitary gland, adrenal glands, or elsewhere in your body)
  • imaging studies such as a CT scan or MRI, which can identify tumors on the pituitary or adrenal glands.

    • Cushing syndrome treatment

    Without treatment, Cushing syndrome can be life-threatening.
    If Cushing syndrome is caused by glucocorticoids you are taking to treat another medical condition, you may be able to work with your doctor to gradually and carefully reduce your dose.
    If a tumor is causing the disorder, you may need surgery to remove it. Medical therapies such as cortisol-blocking drugs may also be needed.
    Dr. Nachtigall coauthored a research study on Cushing syndrome, which found that about 10% of people with Cushing syndrome develop an autoimmune disease after they are surgically treated and in remission. Some people have problems with memory and mood afterward as well. These problems may require additional medical therapy, says Dr. Nachtigall, but most symptoms improve after treatment.
    Cushing syndrome may come back, even years later. Being aware of the symptoms of Cushing syndrome, and getting treated early, can help prevent long-term effects.

    Lifestyle changes to help manage Cushing syndrome

    If you have Cushing syndrome, good lifestyle habits are key to avoiding complications. Having a healthy diet and getting regular exercise are essential, says Dr. Nachtigall.
    Blood pressure can be high in people with Cushing syndrome; checking blood pressure and taking blood pressure-lowering medication if required can help. Cushing syndrome also increases the risk of osteoporosis. Maintaining bone strength through exercise and a healthy diet with adequate calcium and vitamin D intake, and making efforts to prevent falls (which can lead to fractures) are also important.

    Exercises To Relieve Joint Pain

    As Many As One In Four American Adults Has Arthritis, A Leading Cause Of Joint Pain. And Those Ach...
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    Exercises To Relieve Joint Pain
    ~8.3 mins read
    A mature woman stretches her shoulder in an outdoor setting; trees are visible behind her, out of focus.
    As many as one in four American adults has arthritis, a leading cause of joint pain. And those aching ankles, knees, hips, wrists, elbows, and shoulders can get in the way of everyday activities, family responsibilities, and work.
    But joint pain isn't something you have to resign yourself to living with. There are steps you can take today — like exercising more — that can help ease your discomfort.

    Causes of joint pain

    There are a number of different reasons your joints might hurt. Some of the most common causes include:
  • injuries, accidents, and fractures
  • osteoarthritis
  • tendinitis
  • overuse
  • autoimmune conditions like lupus and rheumatoid arthritis
  • gout
  • infections.

    • Benefits of exercise to relieve joint pain

    In many of those cases, exercise can help your joints to move with more ease and less pain —even though moving may be the last thing you feel like doing if your joints are sore.
    A mix of moderate-intensity, low-impact cardiovascular exercise and resistance training can improve your strength and flexibility. This article will focus on joint-specific strengthening and stretching exercises. But you should also be doing some form of aerobic (cardio) exercise. Not only is it good for your heart and overall health, but it also helps ease stiffness and lubricate joints, while boosting production of your body's natural painkilling compounds.
    Exercise also delivers relief from stiffness that can set in if you don't stay active enough. "For example, if you have shoulder arthritis and stop moving your shoulder, it will get stiff — to the point where you could develop a condition called frozen shoulder," says Dr. Robert H. Shmerling, senior faculty editor at Harvard Health Publishing and former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center.
    "Over time," continues Dr. Shmerling, "a regular exercise routine can also tamp down systemic inflammation that might be contributing to your joint pain."
    Lastly, staying consistent with exercise can help you lose weight or maintain a healthy weight, which can decrease pressure on painful joints.

    Stretching and strengthening for joint pain relief

    There are several important components of an exercise plan for joint pain relief, including muscle strengthening and stretching.
    Resistance training is essential for building strength in the muscles that surround your sore joints. While it won't reverse damage from a chronic condition like osteoarthritis, Dr. Shmerling says, it may ease some of the pain.
    Stretching improves the flexibility of your muscles, helping you to move your joints through their full range of motion and ward off pain and stiffness.

    Joint-specific exercises

    How you exercise to ease joint pain will depend on the joint that's bothering you. Consider working with a physical therapist or an experienced certified personal trainer to help you design an individualized exercise program.
    The exercises below are generally safe to try, but if you are recovering from a recent injury or have an underlying health condition that causes your pain, it's worth checking with your doctor before you begin.
    A note on terminology. Each time you complete the full movement, that's a "repetition," or "rep." A "set" is a specific number of repetitions.

    Shoulders

    Strengthen: Standing arm raise

    A person holding weights in front of a wallAI-generated content may be incorrect.
    Reps: 10
    Sets: 1 to 3
    Rest: 30 to 90 seconds between sets
  • Start standing with your feet hip-width apart holding a one- to three-pound weight in each hand with your arms at your sides, thumbs facing forward.
  • Squeeze your shoulder blades together and keep your shoulders down as you slowly lift your arms and raise the weights to shoulder height. Keep your elbows soft (not locked) throughout the movement.
  • Pause, then slowly return to the starting position. This is one rep.

    • Stretch: Wall climb

    A man performs the first part of the wall climb exercise as described in the text. A man performs the second part of the wall climb exercise as described in the text.
    Reps: 3 to 4 of each step on each side
    Sets: 1                                                                                                                                              
    Hold: 10 to 30 seconds
  • Start standing facing a wall.
  • Extend your right arm with your elbow soft (not locked) and place your hand on the wall at shoulder height. Slowly walk your fingers upward, stepping in toward the wall as your hand climbs higher.
  • Stop when you feel mild tension in your shoulder. Hold for 10 to 30 seconds.
  • Slowly walk your fingers back down the wall and return to the starting position. Repeat for your desired number of reps.
  • Switch arms and repeat.
  • Turn so that your left side faces the wall. Extend your left arm with your elbow soft (not locked) and place your hand on the wall at shoulder height. Slowly walk your fingers upward, stepping in toward the wall as your hand climbs higher.
  • Stop when you feel mild tension in your shoulder. Hold for 10 to 30 seconds.
  • Slowly walk your fingers back down the wall and return to the starting position. Repeat for your desired number of reps.
  • Switch arms and repeat.

    • Knees

    Strengthen: Seated knee extension

    A person sitting on a chairAI-generated content may be incorrect.
    Reps: 10 per leg
    Sets: 1 to 3
    Rest: 30 to 90 seconds between sets
  • Sit up straight on a chair or bench with your feet flat on the floor and your hands resting on your thighs.
  • On an exhale, slowly lift up your right foot to the level of your hip without locking your knee. Pause, then slowly lower the foot to the starting position.
  • Finish all reps, then repeat with the left leg.

    • Stretch: Hamstring stretch

    A person doing a sit up exerciseAI-generated content may be incorrect.
    Reps: 3 to 4
    Sets: 1
    Hold: 10 to 30 seconds
  • Lie on your back with both knees bent and your feet flat on the floor.
  • Grasp your right leg with both hands behind the thigh.
  • Extend your leg to lift your right foot toward the ceiling, foot flexed. Straighten the leg as much as possible without locking your knee to feel a stretch along the back of your right thigh.
  • Hold for 10 to 30 seconds. Keep your shoulders relaxed on the floor.
  • Return to the starting position and repeat with the left leg. This is one rep.

    • Hips

    Strengthen: Side-lying clam

    A person lying on a matAI-generated content may be incorrect.
    Reps: 10 per side
    Sets: 1 to 3
    Rest: 30 to 90 seconds between sets
  • Lie on your right side, knees bent so your heels are in line with your buttocks. Rest your head on your right arm on the floor.
  • Keep your feet together and your hips stacked and still as you slowly lift your left knee up toward the ceiling. Lift your knee as high as possible without letting your hips or pelvis move.
  • Pause, then slowly return to the starting position.
  • Finish all reps, then repeat on the left side.

    • Stretch: Butterfly pose

    A person sitting on a yoga matAI-generated content may be incorrect.
    Reps: 3 to 4
    Sets: 1
    Hold: 10 to 30 seconds
  • Start sitting on the floor.
  • Bring the soles of your feet together and let your knees fall apart toward the floor.
  • Place your hands on your ankles. Hinge forward from your hips until you feel a stretch in your inner thighs. Maintain a neutral spine with your shoulders down and back and abdominal muscles contracted, and keep your head and chest lifted as you hinge forward.
  • Hold for 10 to 30 seconds.
  • Return to the starting position. This is one rep.

    • Tips for exercising with joint pain

    When your goal is to alleviate joint pain, it helps to keep a few important safety tips in mind during exercise:
  • Warm up before exercising. Spend at least five to 10 minutes preparing your muscles and joints with gentle cardio or dynamic stretches that target the joints you'll be exercising.
  • Start low and slow. Start at a low intensity, slow pace, and light weights, and gradually ramp up over time. You don't want to make your symptoms worse or experience an injury or other setback that sidelines you longer.
  • Listen to your body. If you experience pain during a particular exercise, reduce the intensity or pick a different activity. You may notice some muscle soreness from exercise; this is usually temporary. If the pain worsens or doesn't go away, talk to your doctor.
  • Pick activities you enjoy. You're more likely to stick with exercise you find fun and engaging.
  • Opt for low-impact activities. Swimming, cycling, walking, yoga, Pilates, and tai chi strain your joints less than higher-impact activities like running or tennis.
  • Focus on form. When strength training, pay close attention to your form. Performing exercises with proper form is crucial for getting the most out of the exercise and limiting your risk of injury or pain.
  • Work up to 150 minutes per week. Aim for a total of at least 150 minutes of moderate-intensity aerobic exercise and two sessions each week that include balance and strength training. Start with short sessions of just a few minutes at a time until you feel more comfortable exercising.
  • Don't forget to rest. Training too often can lead to injury and fatigue. Three or four workouts per week is a good benchmark.
    • Exercise photos by Miohael Carroll

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