• Cushing's Syndrome

    (Cushing's Disease; Hypercortisolism)


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


    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 lung, thyroid, kidney, pancreas, or thymus gland.
    Pituitary and Adrenal Glands
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    Risk Factors

    Factors that may increase your chance of Cushing's syndrome include:


    Cushing's syndrome may cause:
    • Weight gain of the upper body and trunk
    • Rounded face
    • Severe fatigue or muscle weakness
    • Easily bruised, thinner skin
    • Purple stretch marks
    • Excess hair growth or acne in women
    • Menstrual disorders, especially infrequent or absent periods
    • Reduced fertility and interest in sex
    • Personality changes or mood swings
    • Bone loss—osteoporosis


    You will be asked 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
    Imaging tests evaluate the pituitary and adrenal glands, and other internal structures. These may include:


    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


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


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

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


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

    The College of Family Physicians of Canada http://www.cfpc.ca


    Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinolo Metabo. 2003;88(12):5593-5602.

    Cushing disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T127665/Cushing-disease. Updated July 31, 2015. Accessed September 29, 2016.

    Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.niddk.nih.gov/health-information/health-topics/endocrine/cushings-syndrome/Pages/fact-sheet.aspx. Updated April 2012. Accessed February 17, 2016.

    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.

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

    Makras P, Toloumis G, Papadogias D, Kaltsas GA, Besser M. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones. 2006;5(4):231-250.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Kim Carmichael, MD
    • Review Date: 03/2017
    • Update Date: 02/17/2016
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