Definition
Cushing's syndrome is a hormone disorder. Cortisol, in normal doses, helps the body manage stress and infection. However, these high levels over a long period of time can cause several health problems.
Causes
Cushing's syndrome is caused by extended exposure to a hormone called cortisol. Prolonged or excess exposure to cortisol may be caused by:
- Long-term use of corticosteroid hormones such as cortisone or prednisone
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Excess production of cortisol by:
- Tumor or abnormality of the adrenal gland.
- Tumor or abnormality of the pituitary gland. In the case of a pituitary tumor, it is called Cushing's disease
- Rarely, tumors of the lungs, thyroid, kidney, pancreas, or thymus gland.
Risk Factors
Factors that increase your chances of getting Cushing's syndrome include obesity with poorly controlled type 2 diabetes, and high blood pressure.
Symptoms
Symptoms may include:
- Weight gain of the upper body and trunk
- Rounded face
- High blood pressure
- Severe fatigue or muscle weakness
- Diabetes
- Easily bruised, thinner skin
- Purple stretch marks
- Excess hair growth or acne in women
- Menstrual disorders, especially infrequent or absent periods
- Diminished fertility and libido
- Personality changes or mood swings
- Psychiatric changes such as depression, anxiety, or psychosis
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may be done to determine the level of cortisol and find a cause.
Tests for cortisol levels may include:
- 24-hour urinary free cortisol level
- Late-evening cortisol saliva/blood level
- Dexamethasone suppression test
Tests to determine the cause of Cushing's Syndrome may include:
- Blood test for adrenocorticotropin hormone (ACTH) level
- High-dose dexamethasone suppression test
- Rarely, a CRH stimulation test
Other tests may help to see if there is a tumor on the pituitary or adrenal glands. Images may be taken with:
Treatment
Treatment of Cushing's syndrome depends on the cause. Talk with your doctor about the best treatment plan for you. Options include:
- Surgical removal of tumor
- Surgical removal of part, all, or both adrenal glands
- Radiation therapy 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
Revision Information
- Reviewer: Kim Carmichael, MD; Brian Randall, MD
- Review Date: 05/2013 -
- Update Date: 05/01/2013 -