Cushing syndrome is a disorder that occurs when your body is exposed to high levels of the hormone cortisol. It may also occur if you take too much cortisol or other steroid hormones.
See also: Cushing's disease (pituitary Cushing's)
Causes, incidence, and risk factors
Other people develop Cushing syndrome because their bodies produce too much cortisol, a hormone normally made in the adrenal gland. Causes of too much cortisol are:
- Cushing's disease, when the pituitary gland makes too much of the hormone ACTH. ACTH then signals the adrenal glands to produce cortisol. Tumor of the pituitary gland may cause this condition.
- Tumor of the adrenal gland
- Tumor elsewhere in the body that produces cortisol
- Tumors elsewhere in the body that produce ACTH (such as the pancreas, lung, and thyroid)
Most people with Cushing syndrome will have:
- Upper body obesity (above the waist) and thin arms and legs
- Round, red, full face (moon face)
- Slow growth rate in children
Skin changes that are often seen:
- Acne or skin infections
- Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
- Thin skin with easy bruising
Muscle and bone changes include:
- Backache, which occurs with routine activities
- Bone pain or tenderness
- Collection of fat between the shoulders (buffalo hump)
- Rib and spine fractures (caused by thinning of the bones)
- Weak muscles
Women with Cushing syndrome often have:
- Excess hair growth on the face, neck, chest, abdomen, and thighs
- Menstrual cycle that becomes irregular or stops
Men may have:
- Decreased or no desire for sex
Other symptoms that may occur with this disease:
- Mental changes, such as depression, anxiety, or changes in behavior
- Increased thirst and urination
Signs and tests
Laboratory tests that may be done to diagnose Cushing syndrome and identify the cause are:
- Serum cortisol levels
- Salivary cortisol levels
- Dexamethasone suppression test
- 24-hour urine for cortisol and creatinine
- ACTH level
- ACTH (cosyntropin) stimulation test
Tests to determine the cause or complications may include:
High cholesterol, including high triglycerides and low high-density lipoprotein (HDL) may also be present.
Treatment depends on the cause.
- Slowly decrease the drug dose (if possible) under medical supervision.
- If you cannot stop taking the medication because of disease, your high blood sugar, high cholesterol levels, and bone thinning or osteoporosis should be closely monitored.
Cushing syndrome caused by a pituitary or a tumor that releases ACTH (Cushing's disease):
- Surgery to remove the tumor
- Radiation after removal of a pituitary tumor (in some cases)
- You may need hydrocortisone (cortisol) replacement therapy after surgery, and possibly continued throughout your life
- Surgery to remove the tumor
- If the tumor cannot be removed, medications to help block the release of cortisol
Removing the tumor may lead to full recovery, but there is a chance that the condition will return.
Survival for people with ectopic tumors depends on the tumor type. Untreated, Cushing syndrome can be life-threatening.
- Enlargement of pituitary tumor
- Fractures due to osteoporosis
- High blood pressure
- Kidney stones
- Serious infections
Calling your health care provider
Call your health care provider if you have symptoms of Cushing syndrome.
Stewart PM, Krone NP. The adrenal cortex. In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 15.
Reviewed by:Nancy J. Rennart, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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