Cushing's Syndrome: Symptoms - Focus on moonface, central obesity, thin skin and fatigue.

Cushing’s Syndrome

It is basically high levels of cortisol or adrenocorticotropic hormone (which leads to high cortisol).
The reasons for the manifestations of the many symptoms relate directly to the actions of these hormones.

Overall symptoms

Most people with Cushing syndrome will have:
• Upper body obesity (above the waist) and thin arms and legs
• Round, red, full face (moon face)
• Slow growth rate in children

Skin changes that are often seen:
• Acne or skin infections
• Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
• Thin skin with easy bruising

Muscle and bone changes include:
• Backache, which occurs with routine activities
• Bone pain or tenderness
• Collection of fat between the shoulders (buffalo hump)
• Thinning of the bones, which leads to rib and spine fractures
• Weak muscles

Women with Cushing syndrome often have:
• Excess hair growth on the face, neck, chest, abdomen, and thighs
• Menstrual cycle becomes irregular or stops

Men may have:
• Decreased fertility
• Decreased or no desire for sex
• Impotence

Other symptoms that may occur with this disease:
• Mental changes, such as depression, anxiety, or changes in behavior
• Fatigue
• Headache
• High blood pressure
• Increased thirst and urination

So how does excess cortisol cause the symptoms “moonface”, central obesity, thin skin and severe fatigue?

Cortisol counteracts insulin, contributing to hyperglycemia via stimulation of hepatic gluconeogenesis and inhibition of the peripheral utilization of glucose by decreasing the translocation of glucose transporters to the cell membrane, especially GLUT4. However cortisol increases glycogen synthesis (glycogenesis) in the liver. Cortisol also acts as an anti-diuretic hormone

Moonface
The reason why fat tends to accumulate where it does is not known, but perhaps it is because there are more stress hormone receptors in the face and body, which are more sensitive to insulin, where skeletal muscle is less sensitive to insulin. Another reason is due to increased mobilization of fat in extremities and deposition in the trunk.

Central obesity
It is generally suggested that stress-induced cortisol weight is usually gained around the waistline, because fat cells in that area are more sensitive to cortisol. The fat cells in your abdomen are richer in stress hormone receptors, are particularly sensitive to high insulin, and are very effective at storing energy – more so than fat cells you would find in other areas of the body.

Thin skin
In laboratory rats, cortisol-induced collagen loss in the skin is ten times greater than any other tissue. It is probable that increasing copper availability for immune purposes is the reason many copper enzymes are stimulated to an extent which is often 50% of their total potential by cortisol. This includes lysyl oxidase, an enzyme which is used to cross link collagen and elastin.

Severe fatigue
This is due to increased catabolism of protein for gluconeogenesis and decreased synthesis of protein (except for in the liver). This leads to muscle weakness and thus fatigue. As the effects of insulin are also reduced, glucose is not being effectively taken into cells, especially skeletal muscle which can also contribute to feeling fatigued.