Cushing's Syndrome

Cushing's syndrome is a condition caused by too much cortisol in the body. In India, by far the commonest cause is long-term, unregulated use of steroid creams, tablets, or injections — for skin conditions, arthritis, allergies, and fake "weight gain" products. This is iatrogenic Cushing's and is entirely preventable.

Typical features

• Round, red "moon" face.
• Central weight gain with thin arms and legs; buffalo hump on upper back.
• Purple stretch marks on abdomen, thighs, upper arms.
• Easy bruising, thin skin, poor wound healing.
• High blood pressure and high blood sugar / new diabetes.
• Muscle weakness (difficulty climbing stairs, rising from floor).
• Osteoporosis and fractures.
• Acne, excess facial hair (in women).
• Irregular periods, low sex drive, infertility.
• Mood changes — irritability, depression, anxiety, psychosis.

Causes

• Steroid medicines (iatrogenic) — oral/injected/topical steroids, including unregulated "fairness creams", "arthritis" mixes, "asthma" shots, and adulterated Ayurvedic powders. The commonest cause in India.
• Pituitary tumour (Cushing's disease) — rare.
• Adrenal tumour — rare.
• Ectopic ACTH (e.g. from a small-cell lung cancer) — uncommon.

Diagnosis

• Ask about all creams, tablets, powders, and injections — including ones not considered "medicine".
• Screening tests: late-night salivary cortisol, 24-hour urine free cortisol, low-dose dexamethasone suppression test.
• Imaging (MRI pituitary, CT adrenal) only if biochemistry confirms Cushing's of non-iatrogenic origin.

Treatment

• Iatrogenic Cushing's: slowly taper the steroid under a doctor — do not stop abruptly (risk of Addisonian crisis). Treat the underlying skin/joint condition with steroid-sparing options.
• Pituitary or adrenal tumours: surgery is the main treatment; radiation or medicines in specific cases.
• During treatment: manage BP, sugar, osteoporosis; pneumocystis prophylaxis in severe cases.
• Mental-health support — depression and anxiety are common and often improve as cortisol falls.

Prevention (the main Indian lesson)

• No OTC use of steroid creams — clobetasol, betamethasone, fairness combinations — especially on the face.
• No long-term oral steroid without medical review; ask about steroid-sparing options.
• Avoid unlabelled Ayurvedic powders sold for joint pain, skin, and "weight" — several are contaminated with potent steroids.
• Always tell a doctor about every cream and powder — including "herbal" — when unexplained features appear.