What are the manifestations of Cushing's syndrome in corticosteroma?

Cushing's syndrome is a manifestation of a benign or malignant tumor of the adrenal gland, as well as an ectopic tumor of various organs that secrete glucocorticoids. Cushing's syndrome also accompanies corticosteroma, a tumor of the adrenal cortex that produces corticosteroids, and Itsenko-Cushing's disease is a pathology of hypothalamic-pituitary origin.

Corticosteroma occurs in a third of all adrenal tumors. In children, corticosteroma is predominantly malignant; in adults, this pathology is more common in women. What are the manifestations of Cushing's syndrome in corticosteroma?

Mechanism of development of Cushing's syndrome in corticosteroma

Corticosteroma is a typical variant of primary hypercortisolism, in which an increased amount of glucocorticoids, primarily cortisol, is secreted. Increased secretion of corticosteroids by the feedback principle inhibits the release of corticotropin by the anterior part of the pituitary gland. This leads to gradual atrophy of the cortical post-tumor tissue not only of the damaged but also of the contralateral adrenal gland. This is the cause of the manifestation of Cushing's syndrome. Benign corticosteroma is more often unilateral, but may be bilateral. Malignant tumors differ from benign ones in their size and mass.

Main clinical manifestations of Cushing's syndrome

Cushing's syndrome with corticosteroma is manifested by typical obesity, which has a dysplastic character with predominant fat deposition in the face ("moon-like" face), shoulder girdle, lower back and abdomen. The upper and lower limbs are sharply thinned as a result of atrophy. The deposition of adipose tissue in the area of ​​the VII cervical vertebra leads to the formation of a "climacteric" hump. Obesity does not always accompany corticosteroma, sometimes body weight increases, but androgenic redistribution of adipose tissue occurs.

Skin disorders in Cushing's syndrome are very common and are represented by skin stretch marks (striae) that are located on the lower abdomen, inner thighs, upper arms, and breasts.

Skin changes are a consequence of excess cortisol. It is thin, dry, it has numerous pustular rashes, petechial hemorrhages, trophic ulcers on the legs may appear. Women are characterized by the appearance of dark thick hair in atypical places for this, along with this, the hair on the head becomes much thinner, softer and falls out a lot.

Early clinical manifestations of Cushing's syndrome with corticosteroma include:

• increased blood pressure;
• severe headaches;
• cardiac arrhythmias.

What are the lesions in the sexual and psycho-emotional sphere in Cushing's syndrome?

The earliest symptoms of corticosteroma include sexual dysfunction. Women develop oligomenorrhea, dysmenorrhea or amenorrhea with further infertility, atrophy of the mammary glands, hirsutism, hypertrophy of the external genital organs, that is, a virilous syndrome is formed. In men, libido decreases, testicular atrophy is possible. Under the influence of hypercortisoneemia, demineralization of bone tissue occurs, against this background, signs of osteoporosis of varying degrees are revealed.

In most patients, a violation of carbohydrate metabolism occurs with the development of steroid diabetes, in which a high level of insulin is determined, ketoacidosis is rarely determined.

The development of Cushing's syndrome in corticosteroma is accompanied by psycho-emotional changes, which are manifested by memory impairment, depressive states and sleep disturbances. The division of corticosteroma into glucosteroma and glucoandrosteroma does not matter, since the clinic for the presence of these tumors is very similar and is characterized by the appearance of Cushing's syndrome.

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