Cushing Syndrome

(Cushing Disease; Hypercortisolism)

by Michelle Badash, MS

Definition

Cushing syndrome is a hormone disorder. Cortisol, in normal doses, helps the body manage stress and infection. However, high levels over a long period of time can cause several health problems.

Causes

Prolonged or excess exposure to cortisol may be caused by:

Long-term use of corticosteroid hormones, such as cortisone or prednisone
Excess production of cortisol by:
- Tumor or abnormality of the adrenal gland.
- Tumor or abnormality of the pituitary gland. In the case of a pituitary tumor, it is called Cushing disease
- Rarely, tumors of the lung, thyroid, kidney, pancreas, or thymus gland.

Pituitary and Adrenal Glands

Risk Factors

Factors that may increase your chance of Cushing syndrome include using corticodsteroids to treat diseases, such as:

Symptoms

Cushing syndrome may cause:

Weight gain of the upper body and trunk
Rounded face
Severe fatigue or muscle weakness
Easily bruised, thinner skin
Purple stretch marks
Excess hair growth or acne in women
Menstrual disorders, especially infrequent or absent periods
Reduced fertility and interest in sex
Personality changes or mood swings
Bone loss— osteoporosis

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Tests may be done to determine the level of cortisol and find a cause.

Blood tests, urine tests, and saliva tests may be done.

Imaging tests evaluate the pituitary and adrenal glands, and other internal structures. These may include:

Treatment

Treatment of Cushing syndrome depends on the cause. Talk with your doctor about the best treatment plan for you. Options include:

Gradual withdrawal of cortisone-type drugs under close medical supervision
Surgical removal of tumor
Surgical removal of part, all, or both adrenal glands
Radiation therapy for some persistent tumors
Drugs that decrease cortisol production or block the functioning of other adrenal products

Prevention

Work with your doctor to keep your use of corticosteroid drugs to a minimum.

RESOURCES:

Cushing's Support and Research Foundation
http://www.CSRF.net

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinolo Metabo. 2003;88(12):5593-5602.

Cushing disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T127665/Cushing-disease . Updated June 15, 2017. Accessed March 5, 2018.

Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at:
...(Click grey area to select URL)
Updated April 2012. Accessed March 5, 2018.

Diez JJ, Iglesias P. Pharmacological therapy of Cushing’s syndrome: drugs and indications. Mini Rev Med Chem. 2007;7(5):467-480.

Kirk LF Jr, Hash RB, Katner HP, Jones T. Cushing's disease: clinical manifestations and diagnostic evaluation. Am Fam Physician. 2000;62(5):1119-1127.

Tritos NA, Biller BM, Swearingen B. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279-289.

Makras P, Toloumis G, Papadogias D, Kaltsas GA, Besser M. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones. 2006;5(4):231-250.

Last reviewed March 2018 by EBSCO Medical Review Board Alan Drabkin, MD
Last Updated: 2/17/2016

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