Cushing's syndrome is a
rare hormonal problem. It happens when there is too much of the
hormone cortisol in your body.
cortisol levels increase through a chain reaction of hormones:
But if your body makes too much cortisol—or if you take
certain medicines that act like cortisol—you may start to have symptoms.
Cushing's syndrome may cause weight gain, skin changes, and fatigue. It can
lead to serious problems, such as
high blood pressure,
osteoporosis. If not treated, it can also cause
Another name for Cushing's syndrome is
may be caused by:
around the waist—is the most common symptom.
almost all body systems, so it can cause many other symptoms. These other
symptoms often appear slowly over time and may include:
Sometimes alcoholism, depression,
panic attacks, obesity, or other problems can cause
symptoms like these. Some treatments for
HIV can also cause similar symptoms. This is called
pseudo-Cushing's syndrome. In these cases, symptoms tend to stop as soon as the
problems are treated.
will use your medical history, a physical exam, and lab tests to see if you
have Cushing's syndrome. During the physical exam, he or she will look for
signs of the problem. The medical history includes questions about your
symptoms, what medicines you take, and—if you are a woman—whether your periods
If your doctor thinks you may have Cushing's
syndrome, you will have lab tests to check your cortisol levels. These tests
can measure cortisol in your blood, urine, or saliva. More tests may be needed
to find the cause of high cortisol levels.
Cushing's syndrome can often be
cured. But it can lead to serious health problems, including death. So it's
important to start treatment right away.
If steroid medicine is
causing Cushing's syndrome, your doctor will help you lower your dose or
gradually stop taking it. It may take a while for the symptoms to go away.
It's very dangerous to stop taking steroid medicine on your own.
Your doctor will help you change your medicine or lower your dose
If a tumor is causing Cushing's syndrome, you will need
surgery to remove it. If surgery doesn't work, radiation or medicines may be
When you have Cushing's syndrome, it's very important to
control your weight and keep your bones and muscles strong. This will help
prevent diabetes, bone loss, and high blood pressure. Eating healthy foods and
staying active can help you do this.
It's also important to have
regular checkups to look for other problems such as diabetes, high blood
pressure, and osteoporosis.
Learning about Cushing's syndrome:
Living with Cushing's syndrome:
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The signs and symptoms of
Cushing's syndrome vary and most often develop
gradually. You may have:
The eye conditions
cataracts also may occur in Cushing's syndrome. In
Cushing's disease (tumors on the
pituitary gland), your field of vision can be
affected. You may have loss of side, or peripheral, vision.
cancerous tumor on the lung is the cause, you may have rapid loss of appetite
(anorexia) and weight loss. You also may have dark
spots on the skin (hyperpigmentation).
Not everyone who has the
classic signs and symptoms of Cushing's syndrome has the disorder. Also, not
everyone who has Cushing's syndrome has the classic changes in physical
appearance. This is often true in people who are very physically active.
Cushing's syndrome can be difficult to diagnose because a variety of factors—from
the time of day to a temporary illness—can lead to a higher-than-average
cortisol level in people who do not have Cushing's
syndrome. It also can be hard to pinpoint the cause. This is important,
because treatment depends on the cause. You may need to see an
endocrinologist (a doctor who specializes in hormone
disorders) to diagnose or treat Cushing's syndrome.
Cushing's syndrome, your doctor will ask about your
medicines, symptoms, history of cancer or smoking, and any changes to your menstrual periods (if you are a woman). Your doctor will also do a physical exam. He or she will check for high blood pressure and look at your skin for color changes, bruising, stretch marks, and changes in thickness. Your doctor will also check for changes in your weight and for any signs of cancer. Your doctor can usually find out
from these exams whether
corticosteroid medicine is causing the condition. If
it is, other tests usually are not done and your doctor will consider changing
If you are not taking steroid medicine or your
doctor believes something other than steroid medicine is causing Cushing's
syndrome, you will have laboratory tests to check your level of cortisol. These
If the above tests show you have Cushing's syndrome, the
following blood tests can help your doctor find out the amount of
adrenocorticotropic hormone (ACTH) in your body and
whether you have a tumor on the
adrenal glands, the
pituitary gland, or an organ:
If the first tests show that too much ACTH is causing
Cushing's syndrome, other tests may be needed to find out its source. These
Blood test results showing changes in body chemistry also
may point to Cushing's syndrome. These include:
Cushing's syndrome depends on the cause.
corticosteroid medicine is the cause of Cushing's syndrome, your doctor will help you lower your dose or
gradually stop taking it. Never stop taking
corticosteroid medicine on your own, because it might
lead to a life-threatening adrenal crisis. When you take steroids, your
adrenal glands stop making
cortisol. If you suddenly stop taking your medicine,
your adrenal glands may not be able to start making cortisol quickly enough.
This can lead to an adrenal crisis and a severe drop in blood pressure. To
avoid this, your doctor will want to gradually reduce and then stop your
Your doctor may change your corticosteroid medicine from
a longer-acting steroid (such as prednisone) to a shorter-acting one (such as
hydrocortisone). Sometimes corticosteroid medicines can be taken every other
day. Either way, the body's normal production of cortisol returns
If you must continue taking corticosteroid medicine to
control another condition, the dosage can sometimes be lowered to reduce
symptoms and the risk of complications.
If your doctor and you are
trying to reduce the dosage of your medicine and you become ill, contact your
If reducing the dosage does not make Cushing's
syndrome go away, your doctor will perform more tests to look for another cause
of your condition.
If you are well enough to have surgery, surgical removal
of the pituitary tumor offers the best chance for recovery. The surgery (transsphenoidal adenomectomy) requires great skill and
should be performed at a major medical center where teams of doctors specialize
in pituitary surgery.
Gamma knife radiosurgery
has recently been introduced in the United States. In this technique, many
small beams of
radiation are focused on the tumor to shrink and
destroy it. It does not involve a surgical incision (there is no "knife"
involved), and there is minimal damage to surrounding tissue. It can be done as
an outpatient and with
local anesthesia. Few centers in the United States
have gamma knife facilities.
Medicine therapies may be tried if
surgery is not possible or has failed.
Doctors almost always recommend surgery to remove benign adrenal tumors
that are producing hormones. If a tumor is cancerous, the affected adrenal
gland is removed. Although chemotherapy is usually advised, there is no proven
long-term treatment for adrenal cancer. On rare occasions, both adrenal glands
must be removed. In this case, you would take daily long-term hormone
Surgery is usually successful if the tumor is not
cancerous. If the tumor is cancerous, success depends on how much the cancer has spread.
If surgery is not possible, medicine therapy may be tried to reduce the
tumor's production of cortisol. This includes using ketoconazole (Nizoral),
mitotane (Lysodren), and aminoglutethimide (Cytadren). These medicines also are
sometimes used before surgery in people who have severe Cushing's syndrome.
Pregnant women who have Cushing's disease can take aminoglutethimide.
To successfully treat Cushing's syndrome caused by a
noncancerous (benign) or cancerous tumor, the tumor tissue that is secreting
adrenocorticotropic hormone (ACTH) must be destroyed
or removed. Surgery, chemotherapy, radiation therapy, immunotherapy, or a
combination of treatments may be recommended to treat the tumor.
If left untreated for a long time, Cushing's syndrome
may cause serious problems, including complications from
high blood pressure (such as a
heart attack or
type 2 diabetes. The condition also can cause death. Because
of these risks, treatment usually begins as soon as possible.
Home treatment for
Cushing's syndrome consists of lifestyle changes to
prevent weight gain, to strengthen muscles and bones, and to prevent
If you do not have Cushing's syndrome but are taking
corticosteroid medicines, talk to your doctor about
whether you are at risk for the syndrome. Your doctor may reduce
your dosage, treat your condition with a different medicine, or prescribe a
shorter-acting corticosteroid medicine.
The Cushing's Support and Research Foundation offers consumer
pamphlets and other information. The organization also publishes a
The Hormone Health Network is a nonprofit organization
started by the Endocrine Society. The organization promotes the prevention,
treatment, and cure of hormone-related conditions through public outreach and
The National Adrenal Diseases Foundation is a consumer-based
organization providing information and support for people with adrenal-related
The National Endocrine and Metabolic Diseases Information Service
is a service of the National Institute of Diabetes and Digestive and Kidney
Diseases, National Institutes of Health. This Web site offers consumer
information on the cause, treatment, and effects of endocrine and metabolic diseases.
The Pituitary Network Association is a nonprofit
organization that provides support for people who have pituitary tumors and
Other Works ConsultedAlmeida MQ, Stratakis CA (2011). Cushing’s syndrome. In ET Bope et al., eds., Conn’s Current Therapy 2011, pp. 653–659. Philadelphia: Saunders.Carroll TB, et al. (2011). Glucocorticoids and adrenal androgens. In DG Gardner, D Shoback, eds., Greenspan’s Basic and Clinical Endocrinology, 9th ed., pp. 285–327. New York: McGraw-Hill.Loriaux DL (2009). Adrenal. In EG Nabel, ed., ACP Medicine, section 3, chap. 4. Hamilton, ON: BC Decker.Nieman L, et al. (2008). The diagnosis of Cushing's syndrome: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 93(5): 1526-1540.Stewart PM, Krone NP (2011). The adrenal cortex. In S Melmed et al., eds., Williams Textbook of Endocrinology, 12th ed., pp. 479–544. Philadelphia: Saunders.
January 10, 2012
E. Gregory Thompson, MD - Internal Medicine & David C.W. Lau, MD, PhD, FRCPC - Endocrinology
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