Is there a significant overlap between Cushing's syndrome and connective tissue disorders?

From the Guidelines

There is a significant overlap between Cushing's syndrome and connective tissue disorders, as evidenced by the fact that Cushing's syndrome can cause connective tissue weakening, leading to symptoms that mimic or overlap with connective tissue disorders, such as thin, fragile skin, easy bruising, and poor wound healing 1.

Key Points to Consider

• Cushing's syndrome, characterized by excess cortisol production, can cause connective tissue weakening throughout the body, leading to symptoms that overlap with connective tissue disorders.
• The excess cortisol in Cushing's inhibits collagen synthesis and increases collagen degradation, directly affecting the structural integrity of connective tissues.
• Cushing's can cause osteoporosis and bone fragility, which are also seen in some connective tissue disorders, such as systemic sclerosis, as described in the study by 1.
• The immune dysregulation in Cushing's can further complicate the clinical picture, as many connective tissue disorders have autoimmune components.
• Differential diagnosis can be challenging, requiring comprehensive evaluation including cortisol testing, imaging studies, and sometimes genetic testing to distinguish between primary connective tissue disorders and secondary connective tissue manifestations of Cushing's syndrome.

Clinical Implications

• Clinicians should be aware of the potential overlap between Cushing's syndrome and connective tissue disorders, and consider Cushing's syndrome in the differential diagnosis of patients with connective tissue disorders.
• Early recognition and treatment of Cushing's syndrome can help prevent long-term complications, such as osteoporosis and cardiovascular disease, which are also common in connective tissue disorders, as discussed in the study by 1.
• A comprehensive treatment plan should address both the underlying Cushing's syndrome and the connective tissue disorder, taking into account the potential interactions between the two conditions.

From the Research

Cushing's Syndrome and Connective Tissue Disorders

• The provided studies do not directly address the overlap between Cushing's syndrome and connective tissue disorders 2, 3, 4, 5.
• However, one study discusses scleroderma overlap syndrome, which is an entity that satisfies the criteria of at least two connective tissue diseases (CTD) 6.
• This study found that the coexistence of systemic sclerosis (SSc) and another CTD, such as dermatomyositis or polymyositis, Sjogren's syndrome, rheumatoid arthritis, or systemic lupus erythematosus, can aggravate the clinical course, especially lung, kidney, digestive, vascular, and articular involvement 6.
• The use of high-dose corticosteroids for complications of a CTD can be hazardous, especially in patients with scleroderma overlap syndrome, and the use of novel biological therapies may be advocated to avoid these hazards 6.
• While there is no direct evidence of a significant overlap between Cushing's syndrome and connective tissue disorders, the study on scleroderma overlap syndrome suggests that patients with CTD may be at risk of developing complications that require corticosteroid treatment, which can be related to Cushing's syndrome 6.

Key Findings

• Scleroderma overlap syndrome is a condition that satisfies the criteria of at least two connective tissue diseases (CTD) 6.
• The coexistence of SSc and another CTD can aggravate the clinical course, especially lung, kidney, digestive, vascular, and articular involvement 6.
• The use of high-dose corticosteroids for complications of a CTD can be hazardous, especially in patients with scleroderma overlap syndrome 6.
• Novel biological therapies may be advocated to avoid the hazardous influences of high-dose steroids in patients with scleroderma overlap syndrome 6.