It’s nothing new for celebrities, particularly women, to get unwanted and downright mean comments from the public about their appearance.
American comedian Amy Schumer got a recent wave when people deluged social media with observations that her face had become unusually puffy.
The unsolicited remarks led her to seek medical help and then a diagnosis of a rare hormonal disorder called Cushing’s Syndrome.
What is Cushing’s Syndrome?
Dr. Ehud Ur, an endocrinologist at St. Paul’s Hospital, says Cushing’s Syndrome is an umbrella term for conditions and symptoms in which people have elevated levels of the steroid hormone cortisol.
There are about 2000 cases in Canada at any given time, and the condition is three times more prevalent in women than men. (As an aside, it is quite common in dogs, Dr. Ur notes.)
The adrenal glands, which sit atop the kidneys, make the hormone, which regulates the body’s stress levels. But Dr. Ur says an excess can lead to the full face that Schumer developed, along with other symptoms like:
- acne,
- fat deposits in the abdomen and the back of the neck,
- loss of weight in the limbs,
- facial redness,
- easy bruising, and
- stretch marks.
Over time, Cushing’s Syndrome can lead to diabetes, high blood pressure, a predisposition to blood clots, and infections, he says. Along with those physical problems, “It’s a socially obvious disease with the rounding of the face and weight gain,” which can be emotionally distressing for patients. It is usually diagnosed with blood, saliva, and other tests.
What is the cause?
Dr. Ur says patients may be receiving cortisol as a steroid treatment for other health conditions causing inflammation, like asthma.
Indeed, Schumer said that she had been getting treated with high doses of steroid for another undisclosed health condition. She posted that she was relieved that her Cushing’s will resolve itself once those medications are tapered off.
Cushing’s Disease
Other people may need more serious interventions.
Dr. Ur says Cushing’s Disease, which falls under Cushing’s Syndrome, is a benign tumour on the pituitary gland in the brain that usually requires surgical removal.
Fortunately, these tumours aren’t common. About 75 cases are reported in British Columbia each year, says Dr. Ur. In 50 to 75 per cent of those, surgery is successful. “But half to a third of patients need further treatment to block the adrenal glands from producing the cortisol.”
This can include treatment with medications such as ketoconazole, which tamps down the body’s production of cortisol.
Radiation therapy may be required to shrink any residual part of the tumour.
And in extreme cases, surgeons remove the adrenal glands altogether. “That would lead to longer-term steroid replacement,” says Dr. Ur.
Cushing’s Disease, identified by Boston neurosurgeon Harvey Cushing in the early 1900s, is not genetic, and with treatments, is not as fatal as it used to be. However, says Dr. Ur, “it probably shortens life expectancy by 5-10 years.”
Schumer told the newsletter News Not Noise that despite the online hate she received, now that she knows what was causing her symptoms, “I feel reborn.”
She also used her experience as a reminder that people never know what is going on with someone. “Everyone is struggling with something. Maybe we can all be a little kinder to each other and ourselves.”
Story by Ann Gibbon, Providence Health Care
