Cushing's Syndrome

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(Cushing's Disease; Hypercortisolism)

Definition

Cushing's syndrome is a hormone disorder. Cortisol, in normal doses, helps the body manage stress and infection. However, these high levels over a long period of time can cause several health problems.

Causes

Cushing's syndrome is caused by extended exposure to a hormone called cortisol. Prolonged or excess exposure to cortisol may be caused by:
  • Long-term use of corticosteroid hormones such as cortisone or prednisone
  • Excess production of cortisol by:
    • Tumor or abnormality of the adrenal gland.
    • Tumor or abnormality of the pituitary gland. In the case of a pituitary tumor, it is called Cushing's disease
    • Rarely, tumors of the lungs, thyroid, kidney, pancreas, or thymus gland.
Pituitary and Adrenal Glands
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Risk Factors

Factors that increase your chances of getting Cushing's syndrome include obesity with poorly controlled type 2 diabetes, and high blood pressure.

Symptoms

Symptoms may include:
  • Weight gain of the upper body and trunk
  • Rounded face
  • High blood pressure
  • Severe fatigue or muscle weakness
  • Diabetes
  • Easily bruised, thinner skin
  • Purple stretch marks
  • Excess hair growth or acne in women
  • Menstrual disorders, especially infrequent or absent periods
  • Diminished fertility and libido
  • Personality changes or mood swings
  • Psychiatric changes such as depression, anxiety, or psychosis

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may be done to determine the level of cortisol and find a cause.
Tests for cortisol levels may include:
  • 24-hour urinary free cortisol level
  • Late-evening cortisol saliva/blood level
  • Dexamethasone suppression test
Tests to determine the cause of Cushing's Syndrome may include:
  • Blood test for adrenocorticotropin hormone (ACTH) level
  • High-dose dexamethasone suppression test
  • Rarely, a CRH stimulation test
Other tests may help to see if there is a tumor on the pituitary or adrenal glands. Images may be taken with:

Treatment

Treatment of Cushing's syndrome depends on the cause. Talk with your doctor about the best treatment plan for you. Options include:
  • Surgical removal of tumor
  • Surgical removal of part, all, or both adrenal glands
  • Radiation therapy for some persistent tumors
  • Gradual withdrawal of cortisone-type drugs under close medical supervision
  • Drugs that decrease cortisol production or block the functioning of other adrenal products

Prevention

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

RESOURCES

American Academy of Family Physicians http://familydoctor.org

Cushing's Support and Research Foundation http://www.CSRF.net

CANADIAN RESOURCES

Canadian Family Physician http://www.cfpc.ca

Health Canada http://www.hc-sc.gc.ca

References

Arnaldi G, Angeli A, Atkinson AB, Bertagna X, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinolo Metabo. 2003;88:5593-5602.

Cushing's Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm. Updated April 6, 2012. Accessed May 1, 2013.

Cushing disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 3, 2013. Accessed May 1, 2013.

Diez JJ, Iglesias P. Pharmacological therapy of Cushing’s syndrome: drugs and indications. Mini Rev Med Chem. 2007;7(5):467-480.

Kirk LF Jr, Hash RB, Katner HP, Jones T. Cushing's disease: clinical manifestations and diagnostic evaluation. Am Fam Physician. 2000;62(5):1119-1127, 1133-1134.

Tritos NA, Biller BM, Swearingen B; Medscape. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279-289.

Makras P, Toloumis G, Papadoglas D, et al. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones. 2006;5:231-250.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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