Cushing’s Syndrome

What is Cushing's syndrome?

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Cushing’s syndrome is a hormonal condition also called hypercortisolism. Cortisol is a stress hormone that helps control motivation, mood, and fear. Hypercortisolism occurs when people experience high levels of the cortisol hormone. The adrenal glands, located at the top of the kidneys, manufacture cortisol, and there are cortisol receptors all over the body.

Cortisol helps the body with several essential functions, including:

  • Decreasing inflammatory responses in the immune system
  • Balancing insulin effects
  • Managing cardiovascular system and blood pressure
  • Responding to stress
  • Changing proteins, fats, and carbohydrates into energy

What causes Cushing's syndrome?

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Increased levels of the cortisol hormone cause Cushing’s syndrome. Several conditions can cause a spike in cortisol, including:

  • Increased stress levels due to injury, acute illness, pregnancy, or surgery
  • Panic disorders, depression, or increased emotional stress
  • Alcoholism
  • Malnutrition
  • Athletic training

Another significant cause of Cushing’s syndrome is using high doses of corticosteroid medications for an extended period of time. Corticosteroid medications, like prednisone, are often a treatment for inflammatory diseases. Injectable steroids, used for back pain treatment, are another cause of Cushing’s syndrome.

Tumors can also lead to Cushing’s syndrome, including:

  • Ectopic tumors. These tumors usually occur in the pancreas, thymus gland, thyroid, or lung. They produce adrenocorticotropic hormone (ACTH), which prompts cortisol production in the adrenal glands.
  • Familial Cushing’s syndrome. Some people have an increased chance of producing tumors of the endocrine glands due to their genetic history.
  • Adrenal gland abnormality or tumor. An abnormality or tumor in the adrenal gland can cause inconsistent cortisol production and lead to Cushing’s disease.
  • Pituitary gland tumors. This type of tumor can release an overwhelming amount of ACTH and prompt cortisol production in the adrenal glands, which is called Cushing’s disease.

What are symptoms of Cushing's syndrome?

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Common symptoms of Cushing’s syndrome include:

  • Acne
  • Stretch marks on the abdomen, arms, thighs, and breasts (usually purple in color)
  • Weight gain
  • Muscle weakness
  • Easily bruised skin
  • Slow-healing skin injuries
  • Fatigue
  • Fatty deposits in the face, midsection, and between the shoulders

Other possible symptoms include:

  • Depression
  • Anxiety
  • Mood swings
  • Headaches
  • Infections
  • High blood sugar
  • High blood pressure
  • Osteoporosis
  • Increased urination
  • Increased thirst

Cushing’s syndrome can also affect children. Younger Cushing’s syndrome patients can develop all of the aforementioned symptoms, but they might be more prone to reduced growth rates and obesity.

Women are especially at-risk for developing Cushing’s syndrome. The National Institutes of Health report that women are three times as likely as men to have this condition. In addition to the symptoms listed above, women tend to grow extra body and facial hair. Women might also have irregular menstruation, or stop menstruating at all. If a woman’s Cushing’s syndrome is not treated, she might have issues becoming pregnant.

Though their risk of developing the disease is lower than women, men also have a unique set of Cushing’s syndrome symptoms. Men might develop a low sex drive, reduced fertility, or erectile dysfunction.


Are there any risk factors or groups for Cushing's syndrome?

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Taking high doses of corticosteroids long-term can increase the risk of developing Cushing’s syndrome. Anyone who is prescribed a corticosteroid should check in with their doctor to make sure they are aware of the dosage and how long they are supposed to take the medication.

Some medical conditions increase the risk of developing Cushing’s syndrome, including:

Tumors play a large role in Cushing’s syndrome development. Some people are at higher risk of developing endocrine tumors. However, it is impossible to stop the formation of endocrine tumors.

Women are more likely to develop Cushing’s syndrome, although it does occur in men and children, as well.

How is Cushing's syndrome diagnosed?

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Cushing’s syndrome has a challenging diagnostic process. The condition’s symptoms overlap with many other conditions. If someone is experiencing irregular symptoms, a doctor will review their medical history and perform a physical exam, which can reveal epidermal evidence of Cushing’s syndrome.

A doctor will also run some laboratory tests:

  • Salivary cortisol measurement. This test measures how much cortisol is in an evening saliva sample. People who do not have Cushing’s syndrome experience a drop in cortisol at night, so this test will illuminate if high cortisol levels are present when they should not be.
  • 24-hour urinary free cortisol test. This test reveals the cortisol levels present in urine over a 24-hour period.
  • Low-dose dexamethasone suppression test. This test determines whether dexamethasone can decrease cortisol levels. If those levels do not drop, even after exposure to dexamethasone, then the patient likely has Cushing’s syndrome.

In order to receive proper treatment, a doctor should try to figure out the cause of the patient’s Cushing’s syndrome. A doctor can accomplish this a few different ways, including:

  • Imaging. MRI and CT scans can help identify tumors.
  • High-dose dexamethasone suppression test. This test requires a higher dose of dexamethasone to determine if the patient has a pituitary tumor or an ectopic tumor.
  • Blood adrenocorticotropin hormone (ACTH) test. This blood test can measure the levels of ACTH in the blood and signal a potential adrenal gland tumor.
  • Petrosal sinus sampling. Blood samples from the pituitary and a different part of the body help measure ACTH levels.
  • Corticotropin-releasing hormone (CRH) stimulation test. A shot of CRH helps identify pituitary tumors.

How is Cushing's syndrome treated?

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Ultimately, treatment for Cushing’s syndrome involves lowering cortisol levels in some way.

Several potential medications can reduce cortisol levels, including:

  • Metyrapone
  • Mitotane
  • Mifepristone (typically for patients with glucose intolerance or type 2 diabetes)
  • Pasireotide
  • Ketoconazole

A patient with Cushing’s syndrome might also work with their doctor to adjust their current medication. If the patient is using corticosteroids, they might need to switch medications or lower the dosage under the supervision of their doctor.

If a tumor has caused Cushing’s syndrome, then the patient might need to have the tumor removed surgically. Chemotherapy or radiation therapy can also be an effective treatment if removal is not an option.

What are lifestyle changes that could help with Cushing's syndrome?

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A dietary shift can help curb cortisol levels and mitigate some of the more serious health complications of Cushing’s syndrome.

  • Keep an eye on blood sugar. Cushing’s syndrome can cause high blood glucose. Incorporate whole grains, fruits, vegetables, and fish into a balanced diet.
  • Reduce sodium intake. Hypertension and Cushing’s syndrome are connected, so avoiding excess sodium can help alleviate symptoms of both these conditions.
  • Stop drinking alcohol. Consuming large amounts of alcohol can increase cortisol levels.
  • Focus on vitamin D and calcium. Cushing’s syndrome sometimes causes osteoporosis. Vitamin D and calcium can help make bones stronger and reduce risk of bone fractures.
  • Reduce calorie intake. Cushing’s syndrome often causes weight gain. If someone with this condition pays attention to their daily caloric intake, they might be able to reduce the amount of added weight.

Should you see a doctor for Cushing's syndrome?

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It is especially important to see a doctor if you are taking corticosteroid medication as treatment for arthritis, asthma, or irritable bowel disease. Prolonged use of corticosteroid medication is a main cause of Cushing’s syndrome.

The severity of Cushing’s syndrome will increase if the condition is not treated. See a doctor as soon as you notice any irregular symptoms, so that you can begin a treatment plan right away.

What is the outlook for people living with Cushing's syndrome?

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The outlook for people living with Cushing’s syndrome is dependent on what caused the disease. Because treatment is specific to the cause of Cushing’s syndrome, it is best to see a doctor at the onset of any symptoms.

If a tumor has caused Cushing’s syndrome, it is possible that removing the tumor will treat the condition. In any case, the possibility of recurrence is always present.

Cushing’s syndrome is associated with multiple health conditions. Possible health complications related to Cushing’s syndrome can include:

  • Type 2 diabetes
  • Depression or anxiety
  • High blood pressure
  • Increased bone fractures due to osteoporosis
  • Issues with concentration and memory
  • Muscle atrophy
  • Heart attack
  • Stroke

Untreated Cushing’s syndrome can be fatal, but early treatment can help patients with this condition avoid a worst-case scenario.