When American comedian, writer and actress Amy Schumer, 42, who starred in Trainwreck, Last Comic Standing, and Snatched, appeared on The Tonight Show on US television in February, viewers began to comment online on her rounder face.
If those comments seemed thoughtless or unkind, Schumer has since been reported as responding to them with gratitude, saying: “Thank God for that.” Because of them, she sought a doctor’s advice about her puffy face and was diagnosed with Cushing’s syndrome.
The steroid overload can be described as exogenous – meaning it comes from outside the body, from a medical prescription, say – or endogenous, meaning it is produced by the body’s adrenal glands.
Excessive levels of cortisol can show up as weight gain; obesity; facial puffiness or fullness that is sometimes called “moon face”; swollen limbs; muscle wasting and weakness; a tendency to bruise easily; bone pain or tenderness, and; a significant deposit of fat between the shoulders and above the collarbone, often referred to as a buffalo hump.
If Cushing’s syndrome is left untreated, it can cause significant metabolic disturbances because of a hormone imbalance, Wu says.
How one woman lost weight, regained her health by ditching crash diets
How one woman lost weight, regained her health by ditching crash diets
The first Cushing’s case
It has been 114 years since Dr Harvey Cushing, an American doctor often referred to as the father of modern neurosurgery, saw his first patient with what is now known as Cushing’s syndrome, a 23-year-old woman referred to simply as Minnie G, in 1910.
Cushing’s syndrome occurs when there is a surplus of cortisol in the body. The disease is caused by a tumour in the pituitary gland, a small, pea-sized gland at the base of the brain and in line with the top of the nose.
In a 1912 paper, The Pituitary Body and its Disorders, Cushing described Minnie G’s clinical condition as a “syndrome of painful obesity, hypertrichosis (excessive hair growth), and amenorrhoea (cessation of menstruation), with overdevelopment of secondary sexual characteristics accompanying a low grade of hydrocephalus (build-up of fluid in the brain) and increased cerebral tension”.
He questioned whether this was the consequence of a tumour in the “pituitary, adrenal, pineal [glands] or ovary”.
Two illness types, multiple causes
Wu says there are several causes of Cushing’s syndrome. The most common is a prolonged exposure to steroids, usually prescribed. The patient will have taken oral steroids, injected them or applied them as a cream or lotion.
Steroids are commonly used to treat asthma, skin allergies, rheumatoid arthritis, and other autoimmune conditions.
In some patients, tumours in the pituitary gland may be triggering production of too much adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce excessive cortisol. This is the cause of Cushing’s disease, which is different from the syndrome that Schumer has.
Over time and if left untreated, the complications of either Cushing’s syndrome or disease can significantly affect quality of life and potentially be life-threatening, warns Wu.
Treatment for Cushing’s illnesses
Both the syndrome and the disease are treatable. If the syndrome was caused by taking or applying steroids, they should be stopped if the patient’s condition allows. The disease may be cured by surgical removal of the pituitary tumour, although it may grow back.
In Minnie G’s case, Cushing performed a subtemporal decompression – removing a small piece of skull bone to release pressure in the brain.
Schumer spent hours in MRI machines having scans, and underwent dozens of blood tests, as doctors tried to establish what her problem was and its cause. For a while, she worried she might not be around to see her son grow up.
“Finding out I have the kind of Cushing’s that will just work itself out and I’m healthy was the greatest news imaginable,” she added.
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