Cushing's Syndrome
(Cushing's Disease; Hypercortisolism)
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
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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:
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
RESOURCES:
American Academy of Family Physicians
http://familydoctor.org
Cushing's Support and Research Foundation
http://www.CSRF.net
CANADIAN RESOURCES:
Canadian Family Physician
http://www.cfpc.ca
Health Canada
http://www.hc-sc.gc.ca
REFERENCES:
Arnaldi G, Angeli A, Atkinson AB, Bertagna X, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinolo Metabo. 2003;88:5593-5602.
Cushing's Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm. Updated April 6, 2012. Accessed May 1, 2013.
Cushing disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated April 3, 2013. Accessed May 1, 2013.
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, 1133-1134.
Tritos NA, Biller BM, Swearingen B; Medscape. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279-289.
Makras P, Toloumis G, Papadoglas D, et al. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones. 2006;5:231-250.
Last reviewed May 2013 by Kim Carmichael, MD; Brian Randall, MD
Last Updated: 5/1/2013