Cushing’s syndrome or hypercortisolism, occurs due to abnormally high levels of the hormone cortisol. This can happen for a variety of reasons.
In most cases, getting treatment can help you manage your cortisol levels.
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
In addition to the common symptoms above, there are other symptoms that may sometimes be observed in people with Cushing’s syndrome.
These can include:
- high blood sugar
- increased thirst
- increased urination
- high blood pressure (hypertension)
- a headache
- mood swings
- an increased incidence of infections
Children can have Cushing’s syndrome too, although they develop it less frequently than adults. According to a 2019 study, about
In addition to the symptoms above, children with Cushing’s syndrome may also have:
Cushing’s syndrome is more prevalent in women than in men. According to the National Institutes of Health (NIH), three times as many women develop Cushing’s syndrome compared to men.
Women with Cushing’s syndrome may develop extra facial and body hair.
This most often occurs on the:
- face and neck
Additionally, women with Cushing’s syndrome may also experience irregular menstruation. In some cases, menstruation is absent altogether. Untreated Cushing’s syndrome in women can lead to difficulties becoming pregnant.
As is the case with women and children, men with Cushing’s syndrome can also experience some additional symptoms.
Men with Cushing’s syndrome may have:
Cushing’s syndrome is caused by an excess of the hormone cortisol. 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. Healthcare providers can prescribe these to treat inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ.
High doses of injectable steroids for treatment of back pain can also cause Cushing’s syndrome. However, 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 the condition.
Several kinds of tumors can also lead to a higher production of cortisol.
Some of these include:
- Pituitary gland tumors. The pituitary gland releases too much adrenocorticotropic hormone (ACTH), which stimulates cortisol production in the adrenal glands. This is called Cushing’s disease.
- Ectopic tumors. These are tumors outside of the pituitary that produce ACTH. They usually occur in the lung, pancreas, thyroid, or thymus gland.
- Adrenal gland abnormality or tumor. An adrenal abnormality or tumor can lead to irregular patterns of cortisol production, which can cause Cushing’s syndrome.
- Familial Cushing’s syndrome. Although Cushing’s syndrome isn’t typically inherited, it’s possible to have an inherited tendency to develop tumors of the endocrine glands.
If Cushing’s syndrome is caused by the pituitary gland overproducing ACTH which in turn becomes cortisol, it’s called Cushing’s disease.
As with Cushing’s syndrome, Cushing’s disease affects more women than men.
The overall goal of Cushing’s syndrome treatment is to lower the levels of cortisol in your body. This can be accomplished in several ways. The treatment that you receive will depend on what’s causing your condition.
Your healthcare provider may prescribe a medication to help manage cortisol levels. 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.
- ketoconazole (Nizoral)
- mitotane (Lysodren)
- metyrapone (Metopirone)
- pasireotide (Signifor)
- mifepristone (Korlym, Mifeprex) in individuals with type 2 diabetes or glucose intolerance
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.
If your condition is caused by a tumor, your healthcare provider may want to remove the tumor surgically. If the tumor cannot be removed, your healthcare provider may also recommend radiation therapy or chemotherapy.
Cushing’s syndrome can be particularly difficult to diagnose. This is because many of the symptoms, like weight gain or fatigue, can have other causes. Additionally, Cushing’s syndrome itself can have many different causes.
Your healthcare provider will review your medical history. They’ll ask questions about symptoms, any health conditions you may have, and any medications you may be prescribed.
They’ll also perform a physical exam where they’ll look for signs like buffalo hump, and stretch marks and bruises.
Next, they may order laboratory tests, including:
- 24-hour urinary free cortisol test: For this test, you’ll be asked to collect your urine over a 24-hour period. The levels of cortisol will then be tested.
- Salivary cortisol measurement: In people without Cushing’s syndrome, cortisol levels drop in the evening. This test measures the level of cortisol in a saliva sample that’s been collected late at night to see if cortisol levels are too high.
- Low-dose dexamethasone suppression test: For this test, you’ll be given a dose of dexamethasone late in the evening. Your blood will be tested for cortisol levels in the morning. Normally, dexamethasone causes cortisol levels to drop. If you have Cushing’s syndrome, this won’t occur.
Diagnosing the cause of Cushing’s syndrome
After you receive the diagnosis of Cushing’s syndrome, your healthcare provider must still determine the cause of the excess cortisol production.
Tests to help determine the cause may include:
- Blood adrenocorticotropin hormone (ACTH) test: Levels of ACTH in the blood are measured. Low levels of ADTH and high levels of cortisol could indicate the presence of a tumor on the adrenal glands.
- Corticotropin-releasing hormone (CRH) stimulation test: In this test, a shot of CRH is given. This will raise levels of ACTH and cortisol in people with pituitary tumors.
- High-dose dexamethasone suppression test: This is the same as the low-dose test, except that a higher dose of dexamethasone is used. If cortisol levels drop, you may have a pituitary tumor. If they don’t you may have an ectopic tumor.
- Petrosal sinus sampling: Blood is drawn from a vein near the pituitary and also from a vein far away from the pituitary. A shot of CRH is given. High levels of ACTH in the blood near the pituitary can indicate a pituitary tumor. Similar levels from both samples indicate an ectopic tumor.
- Imaging studies: These can include things like CT and MRI scans. They’re used to visualize the adrenal and pituitary glands to look for tumors.
Although dietary changes won’t cure your condition, they can help to keep your cortisol levels from rising even more or help to prevent some complications.
Some dietary tips for those with Cushing’s syndrome include:
- Monitor your calorie intake. Keeping track of your calorie intake is important since weight gain is one of the main symptoms of Cushing’s syndrome.
- Try to avoid drinking alcohol. Alcohol consumption has been linked with a rise in cortisol levels, particularly
in heavy drinkers, according to a 2007 study.
- Watch your blood sugar. Cushing’s syndrome can lead to high blood glucose, so try not to eat foods that can cause a rise in blood sugar. Examples of foods to focus on eating include vegetables, fruits, whole grains, and fish.
- Cut back on sodium. Cushing’s syndrome is also associated with high blood pressure (hypertension). Because of this, try to limit your sodium intake. Some easy ways to do this include not adding salt to food and carefully reading food labels to check sodium content.
- Make sure to get enough calcium and vitamin D. Cushing’s syndrome can weaken your bones, making you prone to fractures. Both calcium and vitamin D can help to strengthen your bones.
The main risk factor for developing Cushing’s syndrome is taking high-dose corticosteroids over a long period of time. If your healthcare provider has prescribed corticosteroids to treat a health condition, ask them about the dosage and how long you’ll be taking them.
Other risk factors can include:
Some cases of Cushing’s syndrome are due to tumor formation. Although there can be a genetic predisposition to develop endocrine tumors (familial Cushing’s syndrome), there’s no way to prevent tumors from forming.
If you have Cushing’s syndrome, it’s important that it’s properly managed. If you don’t get treatment for it, Cushing’s syndrome can lead to a variety of potentially serious health complications.
These can include:
- osteoporosis, which can increase your risk of bone fractures
- muscle loss (atrophy) and weakness
- high blood pressure (hypertension)
- type 2 diabetes
- frequent infections
- heart attack or stroke
- depression or anxiety
- cognitive difficulties like trouble concentrating or problems with memory
- enlargement of an existing tumor
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 some time for your symptoms to improve. Be sure to ask your healthcare provider for healthy dietary guidelines, keep follow-up appointments, and increase your activity level slowly.
Support groups can help you cope with Cushing’s syndrome. Your local hospital or healthcare provider can provide you with information about groups that meet in your area.