Cushing's Syndrome(Cushing's Disease; Hypercortisolism)

by :: Michelle Badash, MS

Definition

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.

Causes

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

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Risk Factors

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)

Symptoms

Although symptoms may vary, common symptoms of Cushing's syndrome are:

  • Weight gain of the upper body and trunk
  • Face shaped like a moon
  • Skin changes:
    • 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
  • Psychosis
  • Low back pain

Diagnosis

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 11 pm and tested.
  • Dexamethasone suppression test—A synthetic cortisol 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:

  • :: MRI scan —a test that uses magnetic waves to make pictures of the inside of the body
  • :: CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
  • :: Chest x-ray —which may detect tumors in the lungs

Treatment

Treatment of Cushing's syndrome depends on the cause.

Treatments include:

  • 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

Prevention

Work with your doctor to keep use of corticosteroid drugs to a minimum.

RESOURCES:

American Academy of Family Physicians
http://familydoctor.org/

Cushing's Support and Research Foundation
http://www.CSRF.net/

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/cfp/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

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. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm . Updated July 2008. Accessed July 8, 2009.

Diez JJ, Iglesias P. Pharmacological therapy of Cushing’s syndrome: drugs and indications. Mini Rev Med Chem . 2007;7(5):467-480.

Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine . 14th ed. New York, NY: The McGraw-Hill Companies; 2000.

Kirk LF Jr, Hash RB, Katner HP, Jones T. Cushing's disease: clinical manifestations and diagnostic evaluation. Am Fam Physician . 2000;62(5):1119-1127, 1133-1134.

Makras P, Toloumis G, Papadoglas D, et al. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones . 2006;5:231-250.

Yaneva M, Mosnier-Pudar H, Dugue MA, et al. Midnight salivary cortisol for the initial diagnosis of Cushing’s syndrome of various causes. J Clin Endocrinol Metab . 2004;89(7):3345-3351.


Last reviewed July 2010 by :: B. Gabriel Smolarz, 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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