Cushing's Syndrome

Definition

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

Causes

Cushing's syndrome is caused by extended exposure to a hormone called cortisol. 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's disease
  • Rarely, tumors of the lungs, thyroid, kidney, pancreas, or thymus gland.

Pituitary and Adrenal Glands

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Risk Factors

Factors that increase your chances of getting Cushing's syndrome include obesity with poorly controlled type 2 diabetes, and high blood pressure.

Symptoms

Symptoms may include:

• Weight gain of the upper body and trunk
• Rounded face
• High blood pressure
• Severe fatigue or muscle weakness
• Diabetes
• Easily bruised, thinner skin
• Purple stretch marks
• Excess hair growth or acne in women
• Menstrual disorders, especially infrequent or absent periods
• Diminished fertility and libido
• Personality changes or mood swings
• Psychiatric changes such as depression, anxiety, or psychosis

Diagnosis

The doctor will ask 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.

Tests for cortisol levels may include:

• 24-hour urinary free cortisol level
• Late-evening cortisol saliva/blood level
• Dexamethasone suppression test

Tests to determine the cause of Cushing's Syndrome may include:

• Blood test for adrenocorticotropin hormone (ACTH) level
• High-dose dexamethasone suppression test
• Rarely, a CRH stimulation test

Other tests may help to see if there is a tumor on the pituitary or adrenal glands. Images may be taken with:

• MRI
• CT scan
• Chest x-ray

Treatment

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

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

Prevention

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