Cushing syndrome is when your body has abnormally high levels of a hormone called cortisol. This can happen for a variety of reasons, the most common of which is overuse of corticosteroid medications.
Symptoms include a round-shaped face, upper body weight gain, and skin that bruises easily. Women may also notice increased body hair and menstrual irregularities. Men may develop erectile and fertility problems. Children who have this condition are often obese and have a slowed rate of growth.
There is no single definitive test for Cushing syndrome. In addition to a physical examination, blood, saliva, and urine tests are usually required. After diagnosis, additional tests are needed to identify the cause. Treatment will depend on the specific cause. Medications can get cortisol levels under control.
Cushing syndrome is also known as Cushing’s syndrome or hypercortisolism.
Signs and Symptoms of Cushing Syndrome
There are many different symptoms of this condition, the most common of which are:
- weight gain, obesity
- fatty deposits, especially in the face (round "moon" face), between the shoulders, the upper back, and midsection
- stretch marks on the breasts, arms, abdomen, and thighs
- thinning skin that bruises easily
- cuts, insect bites, and infections that are slow to heal
- muscle weakness
- glucose intolerance
- increased thirst
- increased urination
- bone loss
- high blood pressure
- cognitive dysfunction
- anxiety, irritability
Women may also notice extra facial and body hair, as well as absent or irregular menstruation.
Men may also have:
- erectile dysfunction
- loss of sexual interest
- decreased fertility
Children with this condition are generally obese and have a slower rate of growth.
Causes of Cushing Syndrome
This condition is the result of abnormally high levels of a hormone called cortisol. Cortisol is produced by the adrenal glands and helps with a number of your body’s functions, including:
- regulating blood pressure and the cardiovascular system
- reducing the immune system’s inflammatory response
- converting carbohydrates, fats, and proteins into energy
- balancing the effects of insulin
- stress response
Your body may produce high levels of cortisol for a variety of reasons, including:
- high stress levels in the final trimester of pregnancy
- athletic training
- depression or panic disorders
The most common cause of Cushing syndrome is the use of corticosteroid medications (like prednisone) in high doses for a long period of time. These medications are generally prescribed to prevent rejection of a transplanted organ. They are also used to treat inflammatory diseases (like lupus and arthritis). High doses of injectable steroids for treatment of back pain can also cause this syndrome.
Lower dose steroids in the form of inhalants (like those used for asthma) or creams (like those prescribed for eczema) usually are not enough to cause Cushing syndrome.
Other causes include:
- pituitary gland tumor, also known as Cushing’s disease (the pituitary gland releases too much adrenocorticotropic hormone, or ACTH)
- ectopic ACTH syndrome (tumors usually found in the lung, pancreas, thyroid, or thymus gland)
- familial Cushing syndrome (Cushing syndrome is generally not inherited, but there may be an inherited tendency to develop tumors of the endocrine glands)
- adrenal gland abnormality or tumor
You are at increased risk of this disorder if you are obese, or if you have type 2 diabetes with uncontrollable blood glucose levels and high blood pressure.
Diagnosing Cushing Syndrome
There is no single definitive test for Cushing syndrome. The diagnosis involves a thorough physical examination and a review of your medical history and symptoms. Laboratory tests that help with the diagnosis may include:
- 24-hour urinary free cortisol test
- midnight plasma cortisol and late-night salivary cortisol measurements
- low-dose dexamethasone suppression test (LDDST) (blood test)
After the condition is diagnosed, the cause of your excess cortisol production must still be determined. Tests to help determine the cause may include:
- corticotropin-releasing hormone (CRH) stimulation test
- high-dose dexamethasone suppression test (HDDST) (blood test)
- imaging tests such as computed tomography (CT) scan and magnetic resonance imaging (MRI)
This relatively rare condition is usually diagnosed in adults between the ages of 20 and 50.
Treatment for Cushing Syndrome
Treatment will depend on what is causing the problem. Your doctor may prescribe a medication to help control cortisol production and ease symptoms.
If you use corticosteroids, a change in medication or dosage may be required. Do not attempt to change the dosage yourself. Close medical supervision is required.
Tumors can be cancerous (malignant) or noncancerous (benign). Surgical removal may be required. Radiation therapy or chemotherapy may also be recommended.
Complications of Cushing Syndrome
If left untreated, Cushing syndrome can lead to:
- bone loss, bone fractures
- muscle loss and weakness
- high blood pressure
- enlargement of a pituitary tumor
- kidney stones
Cushing syndrome caused by Cushing’s disease (pituitary tumors) can interfere with the production of other hormones.
The sooner you begin treatment, the better the expected outcome. It is important to note that your individual prognosis depends on the specific cause and treatment you receive.
It may take a long time to feel well again. Be sure to ask your doctor for healthy dietary guidelines, keep follow-up appointments, and increase your activity level slowly.
Support groups can help people cope with Cushing syndrome. Your local hospital or doctor can provide you with information on groups that meet in your area.