Health Encyclopedia

Cushing syndrome

Definition

Cushing syndrome is a disease that occurs when your body produces too much of the hormone cortisol. It may also occur if you take too much cortisol or other steroid hormones.

Alternative Names

Hypercortisolism

Causes, incidence, and risk factors

The most common cause of Cushing syndrome is side effects from taking anti-inflammatory steroid medications for conditions such as asthma and rheumatoid arthritis.

The second most common cause is Cushing's disease, which occurs when the pituitary gland makes too much of the hormone ACTH. ACTH stimulates the adrenal glands to produce cortisol.

Cushing's disease affects women more often than men.

Cushing syndrome can also be caused by the following:

Tumor of the pituitary gland or adrenal gland
Tumor elsewhere in the body (ectopic Cushing syndrome)

Symptoms

Abdomen that sticks out and thin arms and legs (central obesity)
Acne or skin infections
Backache
Collection of fat between the shoulders (buffalo hump)
Hair growth on the face
Headache
Impotence (men)
Menstrual cycle stops (women)
Mental changes
Purple marks on the skin of the abdomen, thighs, and breasts
Round, red, and full face (moon face)
Thin skin with easy bruising
Weakness
Weight gain (unintentional)

Other symptoms that may occur with this disease:

Signs and tests

Blood sugar and white blood cell counts may be high. Potassium level may be low.

Laboratory tests are done to confirm high cortisol level. These include:

Blood test to check cortisol level
Dexamethasone suppression test
Urine tests to check cortisol levels

Tests to determine the cause may include:

Abdominal CT
ACTH test
Pituitary MRI

Treatment

Treatment depends upon the cause.

Cushing syndrome caused by corticosteroid use:

Slowly decrease the drug dose (if possible) under medical supervision.

Cushing syndrome caused by a pituitary tumor or tumor that releases ACTH:

Surgery to remove the tumor
Radiation after removal of a pituitary tumor (in some cases)
Hydrocortisone (cortisol) replacement therapy (after surgery, and sometimes continued throughout the patient's life)

Cushing syndrome due to an adrenal tumor:

Surgery to remove the tumor
If the tumor cannot be removed, medications to help block the release of cortisol

Expectations (prognosis)

Removing the tumor may lead to full recovery, but there is a chance that the condition will return.

Survival for people with ectopic tumors depends on the tumor type. Untreated, Cushing syndrome can be life-threatening.

Complications

Diabetes
Enlargement of pituitary tumor
Fractures due to osteoporosis
High blood pressure
Kidney stones
Serious infections

Calling your health care provider

Call your health care provider if you have symptoms of Cushing syndrome.

References

Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing's syndrome: A consensus statement. J Clin Endocrinol Metab. 2003;88:5595-5602.

Review Date:3/18/2008
Reviewed By:Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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