Cushing Syndrome

(Cushing Disease; Hypercortisolism)

Definition

Cushing syndrome is too much of a hormone called cortisol in the blood. In normal doses, this hormone helps the body manage stress and infection. High levels over a long period of time can cause health problems.

Causes

High levels of this hormone may be caused by:

  • Long-term use of corticosteroid hormones, such as cortisone or prednisone
  • Excess production of cortisol from a:
    • Tumor or abnormality of the adrenal gland
    • Tumor or abnormality of the pituitary gland. A person with a pituitary tumor has Cushing disease.
    • Tumors of the lung, thyroid, kidney, pancreas, or thymus gland (rare)

Pituitary and Adrenal Glands

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Risk Factors

This problem is more common in people who use corticosteroids to treat problems, such as:

Symptoms

Problems may be:

  • Weight gain in the upper body and trunk
  • Rounded face
  • Severe fatigue or muscle weakness
  • Easily bruised, thin skin
  • Purple stretch marks
  • Excess hair growth or acne in women
  • Menstrual problems, especially irregular or absent periods
  • Low fertility and interest in sex
  • Personality changes or mood swings

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Blood tests, urine tests, and saliva tests to check a person's levels of cortisol.

Images may be taken to look at the pituitary and adrenal glands and at other internal structures. This may be done with:

Treatment

Treatment of Cushing syndrome depends on the cause. Options are:

  • Stopping or changing corticosteroids
  • Surgical removal of a tumor
  • Surgical removal of part, all, or both adrenal glands
  • Radiation therapy to treat lasting tumors
  • Drugs that decrease the amount of cortisol the body makes or block the way other adrenal products work

Prevention

The risk of this problem may be lowered by limiting long-term corticosteroid use.

RESOURCES:

Cushing's Support and Research Foundation
http://www.CSRF.net
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

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

References:

Cushing disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cushing-disease. Accessed October 22, 2020.
Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at:
...(Click grey area to select URL)
Accessed October 22, 2020.
Nieman LK, Biller BM, et al. Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Aug;100(8):2807-2831.
Last reviewed September 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD
Last Updated: 10/22/2020

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