Cushing syndrome

Cushing syndrome is a disease that occurs when your body produces too much of the hormone cortisol. It may also occur if you use take too much cortisol or other steroid hormones.

See also:

• Cushing's disease (pituitary Cushing's)
• Cushing syndrome caused by adrenal tumor
• Cushing syndrome - exogenous
• Ectopic Cushing syndrome

The most common cause of Cushing syndrome is Cushing's disease, which occurs when the pituitary gland makes too much of the hormone ACTH. ACTH stimulates the adrenal glands to produce cortisol. Cushing's disease affects women more often than men.

Cushing syndrome can also be caused by the following:

• Tumor of the pituitary gland or adrenal gland
• Tumor elsewhere in the body (ectopic Cushing syndrome)
• Long-term use of anti-inflammatory medicines called corticosteroids

• Acne or superficial skin infections
• Backache
• Buffalo hump (a collection of fat between the shoulders)
• Central obesity with protruding abdomen and thin extremities
• Hair growth on the face
• Headache
• Impotence (men)
• Menstrual cycle stops (women)
• Mental changes
• Moon face (round, red, and full)
• Purple marks called striations on the skin of the abdomen, thighs, and breasts
• Thin skin with easy bruising
• Weakness
• Weight gain (unintentional)

Additional symptoms that may be associated with this disease:

• Bone pain or tenderness
• Fatigue
• High blood pressure
• Muscle atrophy
• Red spots on the skin
• Skin blushing or flushing

Blood sugar and white blood cells counts may be high. Potassium level may be low.

Laboratory tests are done to confirm high cortisol level. These include:

• Blood test to check cortisol level
• Dexamethasone suppression test
• Urine and saliva tests to check cortisol levels

Tests to determine the cause may include:

• ACTH test
• Abdominal CT
• Cranial MRI or cranial CT scan

Treatment depends upon the cause. If Cushing syndrome results from the use of corticosteroids, the drug dose must be slowly decreased under medical supervision (if the underlying disease permits).

If the disease is caused by a pituitary tumor or tumor that releases ACTH, surgery to remove the tumor is recommended. Radiation is sometimes also needed after removal of a pituitary tumor. Hydrocortisone (cortisol) replacement therapy is needed after surgery. In some cases, life-long cortisol replacement therapy becomes necessary.

Surgery is often used to treat Cushing syndrome due to an adrenal tumor. If the tumor cannot be removed, certain medications can help block the release of cortisol.

Tumor removal may lead to full recovery, but there is a chance that the condition will return. Survival for people with ectopic tumors depends upon the overall outcome associated with the particular tumor type. Untreated, Cushing syndrome can lead to death.

• Diabetes
• Enlargement of pituitary tumor
• Fractures due to osteoporosis
• High blood pressure
• Kidney stones
• Serious infections

Call your health care provider if you have symptoms of Cushing syndrome.

Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing's syndrome: A consensus statement. J Clin Endocrinol Metab. 2003;88-5595-5602.