Diseases & Conditions

 

Cushing's Syndrome

Diseases & Conditions

 

What is Cushing’s syndrome?

Cushing’s syndrome, also known as hypercortisolism, is a metabolic disorder caused by overproduction of corticosteroid hormones by the adrenal cortex and often involving obesity and high blood pressure.

Every year, an estimated 10-15 per million people are affected with Cushing’s syndrome. Cushing’s syndrome most commonly affects adults between 20 and 50 years old and is more prevalent in females.1

 

What causes Cushing’s syndrome?

Cushing’s syndrome is the result of abnormally high levels of cortisol hormone produced by the adrenal glands. Cortisol hormone helps with a number of body’s functions such as controlling hypertension and the cardiovascular system, coping with stress and regulating the metabolism. However, a high level of cortisol may cause Cushing’s syndrome. A high level of cortisol may originate from outside or from the inside of the body:2

  • Exogenous Cushing’s syndrome:
    • Medications: Corticosteroid medications in high doses to treat inflammatory diseases such as rheumatoid arthritis, lupus and asthma may cause Cushing’s syndrome.
  • Endogenous Cushing’s syndrome:
    • Cushing’s syndrome may be due to the body’s overproduction of cortisol. This overproduction of cortisol could be caused by a benign tumor of the pituitary gland, an ectopic adrenocorticotropic hormone tumor, a primary adrenal gland disease or an inherited disease of familial Cushing’s syndrome.

 

What are the symptoms of Cushing’s syndrome?

Signs and symptoms of Cushing’s syndrome include:3

  • Weight gain
  • Deposits of fat in the face and between the shoulders
  • Purple stretch marks on the breasts, arms, abdomen and thighs
  • Slow healing of cuts, insect bites and infections
  • Weakness
  • Fatigue
  • Excessive thirst
  • Frequent urination
  • Hypertension
  • Headache
  • Anxiety
  • Depression
  • Cognitive dysfunction
  • Excessive hair growth on the face and body in women
  • Irregularity of the menstrual cycle in women
  • Erectile dysfunction in men
  • Decreased libido in men
  • Decreased fertility in men
  • Obesity and slower rate of growth in children

 

How is Cushing’s syndrome diagnosed?

The following tests may help to diagnose Cushing’s syndrome:4

  • Saliva test: Cortisol levels in the saliva are measured. This test is usually carried out at night because the level of cortisol peaks between 11:00 p.m. and midnight.
  • Urinalysis: A 24-hour urine free cortisol collection is done to measure the level of cortisol.
  • Dexamethasone suppression test: This test consists of taking low-dose steroid pills every few hours for several days. Then, a test to measure cortisol in the body is performed.

 

How is Cushing’s syndrome treated?

Treatment for Cushing’s syndrome includes reducing corticosteroid use, surgery, radiation therapy and medications:5

  • Reducing corticosteroid use: Reducing the dosage of corticosteroid with a doctor’s supervision is a way to control signs and symptoms of Cushing’s disease. Non-corticosteroid drugs could be prescribed instead.
  • Surgery: If a tumor is causing Cushing’s disease, a total surgery to remove the tumor is recommended
  • Radiation: Radiation therapy is recommended when a pituitary tumor cannot be removed with surgery.
  • Medications: Medications can be used to control cortisol production when surgery and radiation do not work. Medications are used to control the overproduction of cortisol.

 

 References:

  1. "The American Association of Neurological Surgeons." AANS. (Accessed February 10, 2016)
  2. Healthline http://www.healthline.com/health/cushing-syndrome#SignsandSymptoms2 (Accessed February 10, 2016)
  3. Causes http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/basics/causes/con-20032115 (Accessed February 10, 2016)
  4. WebMD http://www.webmd.com/a-to-z-guides/cushing-syndrome?page=2#1 (Accessed February 10, 2016)
  5. Treatments and drugs http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/basics/treatment/con-20032115 (Accessed February 10, 2016)