Cushing’s syndrome occurs due to abnormally high levels of the hormone cortisol. This can happen for a variety of reasons. The most common cause is overuse of corticosteroid medications.
Your doctor may recommend several different diagnostic tests and treatments. In most cases, medication can help you manage your cortisol levels.
Cushing’s syndrome is also known as Cushing syndrome or hypercortisolism.
The most common symptoms of this condition are:
- weight gain
- fatty deposits, especially in the midsection, the face (causing a round, moon-shaped face) and between the shoulders and the upper back (causing a buffalo hump)
- purple stretch marks on the breasts, arms, abdomen, and thighs
- thinning skin that bruises easily
- skin injuries that are slow to heal
- muscle weakness
- glucose intolerance
- increased thirst
- increased urination
- bone loss
- high blood pressure
- a headache
- cognitive dysfunction
- an increased incidence of infections
Women may also notice extra facial and body hair, as well as absent or irregular menstruation.
Men may also have:
- erectile dysfunction
- a loss of sexual interest
- decreased fertility
Children with this condition are generally obese and have a slower rate of growth.
Your adrenal glands produce cortisol. It 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
- responding to stress
Your body may produce high levels of cortisol for a variety of reasons, including:
- high stress levels, including stress related to an acute illness, surgery, injury, or pregnancy, especially in the final trimester
- athletic training
- depression, panic disorders, or high levels of emotional stress
The most common cause of Cushing’s syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. Doctors can prescribe these medications to prevent rejection of a transplanted organ. They also use them to treat inflammatory diseases, such as 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, such as those used for asthma, or creams, such as those prescribed for eczema, usually aren’t enough to cause Cushing’s syndrome.
Other causes include:
- a pituitary gland tumor in which the pituitary gland releases too much adrenocorticotropic hormone, which is also known as Cushing’s disease
- ectopic ACTH syndrome, which causes tumors that usually occur in the lung, pancreas, thyroid, or thymus gland
- an adrenal gland abnormality or tumor
Familial Cushing’s syndrome is another possible cause. Cushing’s syndrome isn’t typically inherited, but it’s possible to have an inherited tendency to develop tumors of the endocrine glands.
Cushing’s syndrome can have many different causes. The diagnosis is made based on abnormal cortisol levels in the body. Your doctor will perform a physical examination and review your medical history and symptoms. They may also order laboratory tests, including:
- a 24-hour urinary free cortisol test
- midnight plasma cortisol and late-night salivary cortisol measurements
- a low-dose dexamethasone suppression test
After you receive the diagnosis of this condition, your doctor still must determine the cause of the excess cortisol production. Tests to help determine the cause may include a corticotropin-releasing hormone stimulation test and a high-dose dexamethasone suppression test. They may also order imaging studies, such as CT and MRI scans.
Treatment will depend on the cause. Your doctor may prescribe a medication to help. Some medications decrease cortisol production in the adrenal glands or decrease ACTH production in the pituitary gland. Other medications block the effect of cortisol on your tissues.
If you use corticosteroids, a change in medication or dosage may be necessary. Don’t attempt to change the dosage yourself. You should do this under close medical supervision.
Tumors can be malignant, which means cancerous, or benign, which means noncancerous. Surgical removal may be necessary. Your doctor may also recommend radiation therapy or chemotherapy.
If you don’t get treatment for it, Cushing’s syndrome can lead to:
- bone loss
- bone fractures
- muscle loss and weakness
- high blood pressure
- type 2 diabetes
- enlargement of a pituitary tumor
- kidney stones
Cushing’s syndrome due to pituitary tumors can interfere with the production of other hormones.
The sooner you begin treatment, the better the expected outcome. It’s important to note that your individual outlook depends on the specific cause and treatment you receive.
It may take a long time for your symptoms to improve. 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’s syndrome. Your local hospital or doctor can provide you with information about groups that meet in your area.