Cushing syndrome

Definition

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

Alternative Names

Hypercortisolism

Causes, incidence, and risk factors

The most common cause of Cushing syndrome is side effects from taking anti-inflammatory steroid medications for conditions such as asthma and rheumatoid arthritis.

The second most common cause 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)

Symptoms

• Abdomen that sticks out and thin arms and legs (central obesity)
• Acne or skin infections
• Backache
• Collection of fat between the shoulders (buffalo hump)
• Hair growth on the face
• Headache
• Impotence (men)
• Menstrual cycle stops (women)
• Mental changes
• Purple marks on the skin of the abdomen, thighs, and breasts
• Round, red, and full face (moon face)
• Thin skin with easy bruising
• Weakness
• Weight gain (unintentional)

Other symptoms that may occur with this disease:

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

Signs and tests

Blood sugar and white blood cell 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 tests to check cortisol levels

Tests to determine the cause may include:

• Abdominal CT
• ACTH test
• Pituitary MRI

Treatment

Treatment depends upon the cause.

Cushing syndrome caused by corticosteroid use:

• Slowly decrease the drug dose (if possible) under medical supervision.

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)
• Hydrocortisone (cortisol) replacement therapy (after surgery, and sometimes continued throughout the patient's life)

Cushing syndrome due to an adrenal tumor:

• Surgery to remove the tumor
• If the tumor cannot be removed, medications to help block the release of cortisol

Expectations (prognosis)

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.

Complications

• Diabetes
• 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.

References

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.