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  • Cushing's Syndrome

    (Cushing's Disease; Hypercortisolism)

    Definition

    Cushing's syndrome is a hormone disorder. It is caused by extended exposure to a hormone called cortisol. 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

    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)
      • Tumors of the lungs, thyroid, kidney, pancreas, or thymus gland (rare)
    Pituitary and Adrenal Glands
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    Risk Factors

    Chronic use of corticosteroid medicines is increases your risk of Cushing's syndrome.

    Symptoms

    Symptoms may vary. Common symptoms include:
    • 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 delayed growth in children
    • Increased thirst
    • Frequent urination
    • Psychosis
    • Low back pain

    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—Urine is collected for 24 hours and tested.
    • Late-evening cortisol saliva/blood level—Saliva or blood is collected around 11 pm and tested.
    • Dexamethasone suppression test—A synthetic cortisol called dexamethasone is taken by mouth; blood and urine samples may be taken overnight or over several days.
    Tests to determine the cause of Cushing's Syndrome may include:
    • Adrenocorticotropin hormone (ACTH) level—blood test
    • High-dose dexamethasone suppression test—blood and urine samples may be taken overnight or over several days after a high dose of dexamethasone is given
    • CRH stimulation test (rarely done)—ACTH levels are measured after a specific hormone is injected, no response indicates Cushing syndrome
    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. Options include:
    • Surgical removal of tumor (most common treatment option)
    • Surgical removal of part, all, or both adrenal glands
    • Radiation 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/

    Hormone Foundation http://www.hormone.org

    CANADIAN RESOURCES

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

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    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 December 31, 2012.

    Cushing disease. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . UpdatedDecember 17, 2012. Accessed December 31, 2012.

    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.

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