On the Call Her Daddy podcast, American actress and stand-up comedian Amy Schumer, 43, discussed how online abuse from trolls led her to seek medical help, ultimately resulting in a diagnosis of Cushing’s syndrome.
Speaking to podcast host Alex Cooper, in the episode that aired on Wednesday, Schumer said: “I was getting these steroid injections [for scars], and it gave me this thing called Cushing’s syndrome, which I wouldn’t have known if the internet hadn’t come for me so hard.”
She first encountered comments about her “moon face” after photos of her were released in the press a year ago, but only began to take them seriously when doctors also voiced their concerns in the comments.
“Doctors were chiming in the comments, and they were like, no, we think something’s really up – like, your face looks so crazy,” said the comedian on the podcast. “They were like, we think you have something called Cushing’s and it’s about spiking cortisol levels and steroids injections.”
But what exactly is Cushing’s syndrome? And can it be treated?
What is Cushing’s?
“Cushing’s develops when the body produces too much of a hormone called cortisol,” explains Emma Cooper, CEO at The Pituitary Foundation. “Cortisol is made by the adrenal glands (two small glands that lie above each kidney) and is usually involved in regulating blood sugar, the immune system and metabolism, and in helping the body respond to stress.”
There are two names for Cushing’s: Cushing’s syndrome and Cushing’s disease.
“If the source of the problem is the pituitary gland (e.g., a tumour in the pituitary gland) then it is known as Cushing’s disease,” clarifies Cooper. “If the source is elsewhere in the body then the correct term is Cushing’s syndrome.”
What causes it?
Cushing’s can occur spontaneously, known as endogenous Cushing’s.
“In 70% of endogenous Cushing’s cases, the cause is a small benign tumour of the pituitary gland,” says Cooper. “Alternatively, there could be a small growth in another part of your body which is having the same effect (this is called ectopic ACTH). If so, removing this growth will usually solve the problem.
“Endogenous Cushing’s can also be caused by a small growth in one of the adrenal glands.”
The condition can also be caused by long-term treatment with a glucocorticoid, such as prednisolone, adds Cooper.
“Prednisolone is often prescribed to treat asthma, rheumatoid arthritis or ulcerative colitis,” says Cooper.
How common is it?
Cushing’s is diagnosed in around 1.3-1.5 people per million of the population per year, according to The Pituitary Foundation.
“Women are more affected than men but the reason for this is currently unknown,” notes Cooper. “It is most commonly diagnosed in people aged between 30-40 years old, however, children may also be diagnosed.”
What are the symptoms?
The symptoms of Cushing’s are varied and usually develop gradually, so a diagnosis may not be clear for some time.
“Usually, several symptoms are present at once. This can include excessive and sudden (or at times more gradual) onset of weight gain around your trunk,” says Cooper. “Also, people may notice a fatty hump at top of spine/back, weak muscles (especially in your legs) and/or darkening of skin pigmentation.”
And, as shown in Schumer’s case, it often affect’s people’s faces.
“Your face tends to be rounder and redder than normal (a classic symptom of Cushing’s known as ‘moon face’) and you may have developed acne,” explains Cooper.
The condition also sometimes makes people’s bones more brittle.
“Your bones may have become weaker (an X-ray may show a fractured rib for instance), due to steroid-induced osteoporosis (thinning and brittleness of bones) and therefore you have an increased risk of fracture,” they note.
Mood swings, higher blood pressure, irregular periods and a tendency to bruise easily are also symptoms, adds Cooper.
How is it diagnosed?
“The two main tests used to identify Cushing’s are the dexamethasone test and the 24-hour urine test,” says Cooper. “People may also be given a series of blood tests, urine tests and/or saliva tests.
“If these initial tests indicate that Cushing’s is likely, then further tests will be carried out to establish to source of the condition (e.g., location of a tumour, if present).”
What are the treatment options?
The type treatment depends on the root cause of the condition.
For example, people with Cushing’s can be prescribed drugs to lower the amount of cortisol their body is producing, says Cooper. However, sometimes surgery is required.
“If the cause of Cushing’s is a tumour then surgery is usually required to remove this,” explains Cooper. “The type of surgery someone has will depend on where the tumour is in their body.
“After surgery, people may feel worse for some months, or even up to a year, before they begin to feel better. Over time, strength and mood should improve and other symptoms will gradually diminish.”
Hormone treatment may also be required after surgery, to replace cortisol in the body, adds Cooper.
“This is because your body’s usually mechanism for controlling cortisol levels may be ‘switched off’ after being exposed to too much cortisol for too long,” explains Cooper. “These treatments are often given in tablet form.”
