Cushings syndrome
Endocrine glands
Definition:
Cushing's syndrome is a disease caused by increased production of cortisol, or by excessive use
of cortisol or other steroid hormones.
Alternative Names:
Hypercortisolism
Causes, incidence, and risk factors:
Cushing's syndrome is a condition that results from an excess of cortisol, a hormone produced
by the adrenal glands. The most common cause of Cushing's syndrome is Cushing's disease,
caused by excessive production of the hormone ACTH by the pituitary gland. ACTH stimulates
the adrenal glands to produce cortisol.
Cushing's syndrome can be caused by a tumor of the pituitary gland, a tumor of the adrenal
gland, a tumor somewhere other than the pituitary or adrenal glands (ectopic Cushing's
syndrome), or by long-term use of corticosteroids (drugs commonly used to treat conditions such
as rheumatoid arthritis and asthma).
Risk factors for Cushing's syndrome are adrenal or pituitary tumors, long-term therapy with
corticosteroids, and being female.
See also:
Cushing's disease (pituitary Cushing's)
Cushing's syndrome - exogenous
ectopic Cushing's syndrome
Cushing's syndrome caused by adrenal tumor
Symptoms:
moon face (round, red, and full)
buffalo hump (a collection of fat between the shoulders)
central obesity with protruding abdomen and thin extremities
weight gain (unintentional)
weakness
backache
headache
acne or superficial skin infections
thin skin with easy bruising
thirst
increased urination
purple striations on the skin of the abdomen, thighs, and breasts
mental changes
impotence or cessation of menses
facial hair growth
Additional symptoms that may be associated with this disease:
skin spots, red
skin blushing / flushing
muscle atrophy
fatigue
bone pain or tenderness
high blood pressure
Signs and tests:
Tests to confirm high cortisol level:
cortisol, urine
dexamethasone suppression test
serial serum cortisol levels
Tests to determine the cause:
ACTH
cranial MRI or cranial CT scan may show pituitary tumor
abdominal CT may show adrenal mass
General findings:
glucose test is elevated
potassium test may be low
white blood cell count may be elevated
Treatment:
Treatment depends upon the cause of the disorder. In Cushing's syndrome caused by drug
therapy with corticosteroids, the drug dose must be slowly decreased under medical supervision.
In Cushing's disease caused by a pituitary tumor, surgery to remove the tumor is recommended.
Radiation is sometimes needed as well. Hydrocortisone (cortisol) replacement therapy is needed
after surgery. In some cases, life-long cortisol-replacement therapy becomes necessary.
Cushing's syndrome caused by an adrenal tumor is usually treated by surgical removal of the
tumor. If the tumor cannot be removed, certain medications can suppress the secretion of
cortisol.
In Cushing's syndrome caused by a tumor secreting ACTH, removal of the tumor is the best way
to treat the Cushing's syndrome. Cortisol replacement therapy is needed after surgery until
cortisol production resumes. In some cases, life-long therapy with cortisone drugs becomes
necessary.
Expectations (prognosis):
Tumor removal may lead to full recovery, but there is a chance of recurrence. Survival for
people with ectopic tumors depends upon the overall outcome associated with the particular
tumor type. Untreated, Cushing's syndrome can lead to death.
Complications:
diabetes mellitus
high blood pressure
serious infections
fractures due to osteoporosis
kidney stones
enlargement of pituitary tumor
Calling your health care provider:
Call your health care provider if symptoms develop that indicate Cushing's syndrome.
Prevention:
Cushing's syndrome may be prevented by an awareness of the associated symptoms so that early
detection can be made.
Review Date: 1/18/2006
Reviewed By: Nikheel S. Kolatkar, MD, Clinical and Research Fellow, Division of
Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical
School, Boston, MA. Review provided by VeriMed Healthcare Network.
