(Cushing's Disease; Hypercortisolism)
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.
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
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.
Pituitary and Adrenal Glands
Factors that may increase your chance of Cushing's syndrome include:
Cushing's syndrome may cause:
- Weight gain of the upper body and trunk
- Rounded face
- Severe fatigue or muscle weakness
- Easily bruised, thinner skin
- Purple stretch marks
- Excess hair growth or acne in women
- Menstrual disorders, especially infrequent or absent periods
- Reduced fertility and interest in sex
- Personality changes or mood swings
You will be asked 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
Other tests may help to see if there is a tumor on the pituitary or adrenal glands. Images may be taken with:
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
Work with your doctor to keep your use of corticosteroid drugs to a minimum.
Cushing's Support and Research Foundation
Family Doctor—American Academy of Family Physicians
The College of Family Physicians of Canada
Arnaldi G, Angeli A, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinolo Metabo. 2003;88:5593-5602.
Cushing disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated February 21, 2014. Accessed February 27, 2014.
Cushing's syndrome. National Endocrine and Metabolic Diseases Information Service website. Available at: http://endocrine.niddk.nih.gov/pubs/cushings/cushings.aspx. Updated April 6, 2012. Accessed February 27, 2014.
Diez JJ, Iglesias P. Pharmacological therapy of Cushing’s syndrome: drugs and indications. Mini Rev Med Chem. 2007;7(5):467-480.
Kirk LF Jr, Hash RB, et al. Cushing's disease: clinical manifestations and diagnostic evaluation. Am Fam Physician. 2000;62(5):1119-1127, 1133-1134.
Tritos NA, Biller BM, et al. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279-289.
Makras P, Toloumis G, et al. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones. 2006;5:231-250.
Last reviewed February 2015 by Kim Carmichael, 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.