Cushing Syndrome

Cushing syndrome is a rare hormonal condition that happens when your body has too much cortisol. Cortisol is an important hormone that controls many bodily functions. But having too much of it can cause symptoms, like a round or full face, weight gain and skin changes. The most common causes of Cushing syndrome are taking corticosteroid medications or developing a tumor on your pituitary or adrenal glands.

Treatment focuses on lowering cortisol levels.

You may also hear this condition called hypercortisolism or Cushing’s syndrome.

Symptoms of Cushing syndrome

Signs and symptoms of Cushing’s can vary. You may have one, many or none of the following signs:

• Weight gain in your face (sometimes called “moon face”)
• Increased fat at the back of your neck or between your shoulders (sometimes called “buffalo hump”)
• Skin changes, like easy bruising or wounds that heal poorly
• Purple or pink stretch marks on your belly, breasts and hips
• High blood pressure
• Diabetes or prediabetes
• Stunted growth in children

Other symptoms could include:

• Fatigue and general weakness
• Mood changes
• Weak muscles and thinner arms and legs
• Loss of libido or erectile dysfunction
• Period changes
• Excess hair growth in females

Cushing syndrome causes

Too much cortisol causes Cushing syndrome. The causes can come from two different sources:

• Endogenous (from within your body): Your body makes too much cortisol, usually due to a tumor on your pituitary or adrenal gland.
• Exogenous(from outside your body): Long-term use of steroid medications can cause high cortisol levels. This is more common.

Several factors can lead to high cortisol levels, including:

• Glucocorticoid medications: Long-term use of glucocorticoid medications (like prednisone, dexamethasone and hydrocortisone) can cause Cushing syndrome.
• Pituitary tumors: Pituitary tumors that make too much ACTH cause 8 out of 10 cases of Cushing syndrome. This is called Cushing disease. ACTH is a hormone that tells your adrenal glands to make cortisol.
• Adrenal cortical tumors: A tumor on your adrenal gland can make too much cortisol. They’re usually not cancerous. But the tumor can very rarely be an adrenocortical carcinoma.
• Ectopic ACTH-producing tumors: Ectopic ACTH syndrome happens when tumors that develop outside of your pituitary gland make ACTH. These types of tumors are usually cancerous.

Risk factors

Anyone can develop Cushing syndrome. But it’s more likely to affect women and people between 25 and 50 years old.

Complications of Cushing syndrome

Without treatment, hypercortisolism can cause health problems, including:

• Increased risk of infections
• Blood clots, especially in your lungs and legs
• Broken bones or weak bones
• High cholesterol
• Prediabetes or Type 2 diabetes
• High blood pressure
• Mood swings
• Abnormal weight gain

If left untreated, Cushing syndrome can result in death. This is mainly because of complications related to diabetes or cardiovascular diseases.

How doctors diagnose Cushing syndrome

Your healthcare provider will ask questions about your symptoms, look at your medical history and do a physical exam. They’ll order tests that check cortisol and other hormone levels.

Cushing’s can be difficult to diagnose. This is because some of its symptoms, like tiredness and weight gain, can have several other causes.

Tests that diagnose this condition

Your healthcare provider may order the following tests:

• 24-hour urinary cortisol test: This test measures the amount of cortisol in your pee. You’ll collect your pee over a period of 24 hours.
• Midnight salivary cortisol test: This test checks cortisol levels between 11 p.m. and 12 a.m., when they’re typically at their lowest.
• Dexamethasone suppression test: This test measures how well your body can suppress cortisol production.
• ACTH blood test: Low levels of ACTH may mean you have an adrenal tumor. If the levels are normal or high, you may have a pituitary or ectopic tumor.

Once your provider diagnoses the condition, they’ll figure out the underlying cause. If you don’t take glucocorticoids, it usually points to a tumor.

Your provider may recommend the following imaging tests to find the tumor:

• CT scan or MRI of your abdomen to look for a tumor in your adrenal glands
• MRI of your pituitary gland
• Bilateral inferior petrosal sinus sampling (BIPPS) to find the source of ACTH secretion
• Chest CT scan to look for lung cancer and an ectopic tumor

How is Cushing syndrome treated?

Cushing’s treatment depends on the underlying cause of high cortisol levels. If you use glucocorticoids, your healthcare provider will lower the dosage or prescribe a different medication. Your provider will carefully evaluate the situation and work on lowering the dose slowly without causing you harm.

If a tumor is causing Cushing syndrome, your provider may suggest surgery or radiation, depending on the location and other factors.

Another option is for your healthcare provider to prescribe a medication that slows down cortisol production.

Treatment depends on the underlying cause. Options include:

• Lowering the dosage of steroid medications or taking a different medication
• Surgery or radiation for tumors
• Medication that slows down cortisol production

Cushing syndrome can get worse without proper treatment. Have regular checkups with your healthcare provider. Let them know of any new or worsening symptoms.

What can I expect if I have Cushing syndrome?

In many cases, treatment will cure Cushing syndrome and improve your symptoms.

You may feel embarrassed by some of the symptoms this disease causes. If it’s taking a toll on your mental health, reach out to a therapist. Joining a support group of others living with the condition may help, too. Your mental health is just as important as your physical health.

What is the life expectancy of someone with Cushing’s disease?

It can be life-threatening without treatment. This is mostly because of the strain it can put on your heart and endocrine system. With the right treatment, your life expectancy shouldn’t be affected.