Cushing's syndrome (hypercortisolism)

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.
Support Groups:
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.