Cushing's Syndrome (Cushing's Disease; Hypercortisolism)
Cushing's syndrome is a hormonal disorder. It is caused by prolonged exposure to the hormone cortisol.
Hormones are chemicals in the body. Cortisol is a common hormone. In normal doses it helps the body manage stress and infection.
Prolonged or excess exposure to cortisol as a result of:
Long-term use of corticosteroid hormones such as cortisone or prednisone Tumor or abnormality of the adrenal gland, which causes the body to produce excess cortisol
Tumor or abnormality of the pituitary gland, which causes the body to produce excess cortisol (in the case of a
it is called Cushing's disease)
Rarely, tumors of the lungs, thyroid, kidney, pancreas, or thymus gland produce hormones that trigger the syndrome Pituitary and Adrenal Glands
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Factors that increase your risk of Cushing's syndrome include:
Chronic use of corticosteroid medicines Age: 20-50 years Sex: female (much more common in women)
Although symptoms may vary, common symptoms of Cushing's syndrome are:
Weight gain of the upper body and trunk Face shaped like a moon
Darkening of the skin Purple stretch marks Easy bruising Excess hair growth or acne in women
Menstrual disorders, especially infrequent or
absent periods Diminished fertility and libido High blood pressure Water retention or swelling
High blood sugar or
diabetes Tiredness or fatigue Personality changes or mood swings Muscle weakness
or brittle bones
Osteoporosis Skeletal growth retardation in children Increased thirst Frequent urination Psychosis Low back pain
The doctor will ask about your symptoms and medical history. A physical exam will be done.
24-hour urinary free cortisol level—urine is collected for 24 hours and tested Late-Evening cortisol saliva/blood level—saliva or blood is collected around 11pm and tested
Dexamethasone suppression test—a synthetic cortisl called
is taken by mouth; blood and urine samples may be taken overnight or over several days
CRH stimulation test ACTH level High-dose dexamethasone suppression test
These tests may show whether there is a tumor in the pituitary or adrenal glands or another area of the body. Common imaging tools include:
—a test that uses magnetic waves to make pictures of the inside of the body
—a type of x-ray that uses a computer to make pictures of structures inside the body
—which may detect tumors in the lungs
Treatment of Cushing's syndrome depends on the cause.
Surgical removal of tumor Surgical removal of part, all, or both adrenal glands Radiation 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
Work with your doctor to keep use of corticosteroid drugs to a minimum.
Arnaldi G, Angeli A, Atkinson AB, Bertagna X, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement.
J Clin Endocrinolo Metabo
Cushing's Syndrome and Cushing's Disease.
Am Fam Physician
Cushing's Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
. Accessed October 7, 2005.
Diez JJ and Iglesias P: Pharmacological therapy of Cusing’s syndrome: drugs and indications. Mini Rev Med Chem 2007;7:467-80.
Fauci AS, Braunwald E, Isselbacher KJ, et al.
Harrison's Principles of Internal Medicine
. 14th ed. New York, NY: The McGraw-Hill Companies; 2000.
Makras P, Toloumis G, Papadoglas D et al: the diagnosis and differential diagnosis of endogenous Cusing’s syndrome. Hormones 2006;5:231-50.
Yaneva M, Mosnier-Pudar H, Dugue MA, Grabar S, Fulla Y, Bertagna X. Midnight salivary cortisol for the initial diagnosis of Cusing’s syndrome of various causes.
J Clin Endocrinol Metab
Last reviewed January 2009 by
Rosalyn Carson-DeW¹itt, MD
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a
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