What Is Cushing's Syndrome?
Cushing’s syndromea relatively uncommon disorder named for the twentieth-century American surgeon who identified itis caused by elevated blood levels of cortisol (an essential corticosteroid hormone). Cortisol is produced by the cortex of the adrenal glands, grape-size organs located above each kidney that form part of the body’s endocrine system. Cortisol secretion is stimulated by the release of adrenocorticotropic hormone, or ACTH, from the pituitary gland.
Cushing’s syndrome is due to overproduction of cortisol by the adrenals or administration of excessive amounts of cortisone in the treatment of a number of diseases. The disorder is known as Cushing’s disease when symptoms are due to increased production of ACTH by a tumor in the pituitary gland. Common complications are hypertension, diabetes mellitus, osteoporosis, and muscle weakness. Both Cushing’s syndrome and Cushing’s disease respond well to treatment.
What Causes Cushing's Syndrome?
- Large or long-term doses of oral corticosteroid medications—prescribed to treat disorders such as rheumatoid arthritis, inflammatory bowel disease, or asthmaare now the most common cause of Cushing’s syndrome.
- An adrenal tumor or overgrowth (hyperplasia) of adrenal cortex cells may cause Cushing’s syndrome.
- A pituitary tumor that secretes excess ACTH overstimulates cortisol production by the adrenal glands and causes Cushing’s disease.
- Occasionally, tumors elsewhere in the body, such as in the lungs, may produce excess ACTH (ectopic ACTH-producing tumor).
Symptoms of Cushing's Syndrome
- A round or “moon-shaped” face
- Fat accumulation on the torso and between the shoulder blades
- Thin legs and arms
- Fatigue and muscle weakness
- Skin changes, including easy bruising; acne; pink or purple stretch marks on the abdomen, thighs, and breasts; thin skin; a reddish appearance of the face
- Changes in mental state, such as mood swings, depression, paranoia, irritability or euphoria
- In men: impotence
- In women: growth of hair (hirsutism); the cessation of menstruation (amenorrhea)
- Back or hip pain from bone fractures due to osteoporosis
- Cuts, scratches and insect bites that take longer than usual to heal
- High blood pressure
- High blood sugar levels
Prevention of Cushing's Syndrome
- If you are taking corticosteroids on a long-term basis, ask your doctor about taking the lowest possible doses of these medications.
Diagnosis of Cushing's Syndrome
- Blood and urine tests to measure levels of adrenal hormones
- CT (computed tomography) scans or MRI (magnetic resonance imaging) of the abdomen or skull (to image the pituitary gland)
- Salivary cortisol test to show cortisol diurnal rhythm
How to Treat Cushing's Syndrome
- If Cushing’s syndrome is caused by long-term treatment with corticosteroid medications, your doctor may gradually reduce the dosage and switch you to another form of treatment, if possible. Never stop taking corticosteroids on your own, because serious side effects may occur; slow withdrawal should be planned and supervised by a doctor.
- If excess cortisol is caused by an ACTH-producing pituitary tumor, treatment often involves removal of the tumor.
- A pituitary or adrenal tumor can be surgically removed.
- Radiation therapy, either alone or in conjunction with surgery, may be used to treat tumors.
- Medications that inhibit the secretion of cortisol, such as ketoconazole, aminoglutethimide, metyrapone, or mitotane, may be prescribed when surgery is impossible or unsuccessful, or when the tumor is malignant.
- Hormone replacement therapy (temporary or lifelong) may be necessary to supplement or replace adrenal and thyroid hormone following surgery or radiation treatment to the pituitary.
The Highlights Project is a collaboration between Novartis and Kevyn Aucoin Beauty that is designed to provide support to those living with the physical manifestations of acromegaly and Cushing's disease through the art of makeup. The initiative is designed to instill confidence, while raising awareness of these conditions. The program offers makeup tutorials, intimate makeup sessions with Kevyn Aucoin Pro Artists and tips to address common concerns expressed by patients living with these diseases.
When to Call a Doctor
- Call a doctor if you develop excess fat on your face and torso, accompanied by any of the other symptoms of Cushing’s syndrome.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media