(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 pituitary tumor]]> 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
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
- ]]>Osteoporosis]]> or brittle bones
- Skeletal growth retardation in children
- Increased thirst
- Frequent urination
- Low back pain
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests for Cortisol Levels
- 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 dexamethasone]]> is taken by mouth; blood and urine samples may be taken overnight or over several days
Tests to Determine Cause of Cushing's Syndrome
- CRH stimulation test
- ACTH level
- High-dose dexamethasone suppression test
X-rays and Scans
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:
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
American Academy of Family Physicians
Cushing's Support and Research Foundation
Canadian Family Physician
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 and Cushing's Disease. Am Fam Physician . 2000;62(5):1133.
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 . 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 . 2004;89:3345-3351.
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 medical condition.
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