Cushings Syndrome

Cushings Syndrome is a hormonal disorder caused by prolonged exposure to the hormone cortisol. It is called Cushings disease when it is caused by a pituitary tumor. All other causes of the condition are termed Cushings Syndrome.

Causes

Prolonged or excess exposure to cortisol as a result of:
  • Long-term use of corticosteroid hormones such as cortisone or prednisone
  • Tumor or abnormality of the adrenal gland, which causes the body to produce excess cortisol
  • Tumor or abnormality of the pituitary gland, which causes the body to produce excess cortisol
  • Rarely, tumors of the lungs, thyroid, ovary, pancreas, or thymus gland

Risk Factors

A risk factor is something that increases your chance of developing a disease or condition.
  • Chronic use of corticosteroid medicines
  • Age: 20-40 years
  • Sex: female (much more common in women)

Symptoms

Although symptoms may vary, common symptoms of Cushing's syndrome are:
  • Weight gain of the upper body and trunk
  • Face shaped like a moon
  • Skin changes:
    • Darkening of the skin
    • Purple stretch marks
    • Easy bruising
  • Excess hair growth or acne in women
  • Menstrual disorders, especially infrequent or absent periods
  • Diminished fertility and libido
  • High blood pressure
  • Water retention or swelling
  • High blood sugar or diabetes
  • Tiredness or fatigue
  • Personality changes or mood swings
  • Muscle weakness
  • Osteoporosis, or brittle bones
  • Skeletal growth retardation in children

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

24-hour Urinary Free Cortisol Level

Urine is collected for 24 hours, and then tested for cortisol.

Dexamethasone Suppression Test

A synthetic cortisol called dexamethasone is taken by mouth either overnight or for several days. Blood or urine cortisol levels are then measured.

CRH Stimulation Test or Metyrapone Test

Either of these two tests may help detect the presence of a pituitary tumor.

X-rays and Scans

These tests may show whether there is a tumor in the pituitary or adrenal glands or another area of the body. Common imaging tools include:
  • MRI scan
  • CT scan
  • Chest x-ray, which may detect tumors in the lungs

Treatment

Treatment of ushings dyndrome depends on the cause.

Treatments include:
  • Surgical removal of tumor
  • Radiation for some persistent tumors
  • Gradual withdrawal of cortisone-type drugs (under close medical supervision)
  • Drugs to suppress adrenal gland function

Prevention

Work with your doctor to keep use of corticosteroid drugs to a minimum.