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)
Cushing syndrome may be caused by taking too much corticosteroid medications, such as prednisone and prednisolone. These drugs are used to treat conditions such as asthma and rheumatoid arthritis.
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)
- Thinning of the bones, which leads to rib and spine fractures
- Weak muscles
Women with Cushing syndrome often have:
- Excess hair growth on the face, neck, chest, abdomen, and thighs
Menstrual cycle becomes irregular or stops
Men may have:
- Decreased fertility
- Decreased or no desire for sex
Other symptoms that may occur with this disease:
Mental changes, such as depression, anxiety, or changes in behavior
High blood pressure
- Increased thirst and urination
Exams and Tests
Blood sugar and white blood cell counts may be high. Potassium level may be low.
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 (cosyntropin) stimulation test
Tests to determine the cause or complications may include:
- ACTH test
- Pituitary MRI
Bone density, as measured by dual x-ray absorptiometry (DEXA)
High cholesterol, including high triglycerides and low high-density lipoprotein (HDL) may also be present.
Treatment depends on the cause.
Cushing syndrome caused by corticosteroid use:
- 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 tumor or tumor that releases ACTH:
- 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
Cushing syndrome due to an adrenal tumor or other tumors:
- 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
- Serious infections
When to Contact a Medical Professional
Call your health care provider if you have symptoms of Cushing syndrome.
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