Cushing Syndrome
What is Cushing Syndrome?
Cushing Syndrome is a condition that happens when your body is exposed to too much cortisol over time. Cortisol is a hormone made by your adrenal glands, which sit on top of your kidneys. It helps control blood sugar, reduce inflammation, and manage stress. When cortisol levels stay too high for weeks or months, it affects nearly every system in your body.
Most cases come from taking corticosteroid medications like prednisone for conditions such as asthma or arthritis. This is called exogenous Cushing Syndrome because the cortisol comes from outside your body. Less commonly, tumors in the pituitary gland, adrenal glands, or elsewhere cause your body to produce too much cortisol on its own. This is called endogenous Cushing Syndrome.
The condition affects about 40 to 70 people per million, making it relatively rare. It most often appears in adults between ages 25 and 40, and women are three times more likely to develop it than men. Early detection through blood testing can help identify cortisol excess before serious complications develop.
Symptoms
- Weight gain, especially in the face, upper back, and around the belly
- Round, red face with extra fat deposits, called moon face
- Purple or pink stretch marks on the abdomen, thighs, breasts, or arms
- Thin skin that bruises easily
- Slow healing of cuts and infections
- Severe fatigue and muscle weakness
- High blood pressure
- High blood sugar or diabetes
- Mood changes including irritability, anxiety, or depression
- Irregular or absent menstrual periods in women
- Reduced sex drive and fertility problems
- Excess hair growth on the face, neck, chest, and abdomen in women
Some people notice only a few symptoms at first, and changes can develop gradually over months or years. The signs may be mistaken for normal aging or weight gain, which delays diagnosis. Children with Cushing Syndrome often show slower growth and shorter height compared to their peers.
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Causes and risk factors
The most common cause is long-term use of corticosteroid medications prescribed for inflammatory conditions like rheumatoid arthritis, lupus, or asthma. These drugs mimic cortisol in your body. When used at high doses or for extended periods, they can trigger Cushing Syndrome. Other causes include pituitary tumors that release excess adrenocorticotropic hormone, which signals the adrenal glands to produce more cortisol. Adrenal gland tumors can also directly produce too much cortisol. Rarely, tumors in the lungs, pancreas, or thyroid release hormones that stimulate cortisol production.
Risk factors include being female, being between ages 25 and 40, and taking corticosteroid medications. People with certain genetic conditions face higher risk of developing tumors that cause Cushing Syndrome. Obesity, diabetes, and poorly controlled blood pressure can result from Cushing Syndrome but may also mask its symptoms. Chronic stress alone does not cause Cushing Syndrome, though elevated cortisol plays a role in both conditions.
How it's diagnosed
Doctors diagnose Cushing Syndrome through a combination of physical exams, medical history, and specialized tests. Blood tests play an important role in identifying signs of cortisol excess. Elevated glucose levels often appear because cortisol increases blood sugar production. Low eosinophil counts, a type of white blood cell, can also indicate high cortisol levels. Cortisol suppresses eosinophil production, and counts below 100 cells per microliter support a diagnosis when other symptoms are present.
Rite Aid offers blood testing that measures glucose and eosinophils as part of our core panel. These biomarkers can reveal patterns consistent with Cushing Syndrome. If results suggest cortisol excess, your doctor will order additional tests such as 24-hour urine cortisol, late-night salivary cortisol, or dexamethasone suppression tests. Imaging studies like MRI or CT scans help locate tumors if present. Early detection through routine blood work allows for faster intervention and better outcomes.
Treatment options
- Reduce or stop corticosteroid medications under medical supervision if they are the cause
- Surgery to remove pituitary or adrenal tumors producing excess cortisol
- Radiation therapy when surgery is not possible or does not remove all tumor tissue
- Medications that block cortisol production, such as ketoconazole, metyrapone, or mitotane
- Manage high blood sugar with diet changes, exercise, and diabetes medications if needed
- Control high blood pressure with medications and reduced sodium intake
- Increase calcium and vitamin D to protect bone health
- Work with a mental health provider to address mood changes and depression
- Physical therapy to rebuild muscle strength after cortisol levels normalize
- Regular follow-up blood tests to monitor glucose, electrolytes, and treatment response
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Frequently asked questions
Cushing Disease is a specific type of Cushing Syndrome caused by a pituitary tumor that makes too much adrenocorticotropic hormone. This hormone tells your adrenal glands to produce excess cortisol. Cushing Syndrome is the broader term for any condition causing too much cortisol, including medication use, adrenal tumors, or tumors elsewhere in the body. All Cushing Disease cases are Cushing Syndrome, but not all Cushing Syndrome cases are Cushing Disease.
Cushing Syndrome caused by corticosteroid medications may resolve after stopping or reducing the drugs under medical guidance. However, cases caused by tumors will not go away without treatment. Untreated Cushing Syndrome leads to serious complications including diabetes, heart disease, bone loss, infections, and mental health problems. Early diagnosis and appropriate treatment are necessary to prevent long-term damage and restore normal cortisol levels.
Cortisol raises blood sugar by increasing glucose production in the liver and reducing insulin sensitivity in cells. About 50 to 70 percent of people with Cushing Syndrome develop high blood sugar or diabetes. Regular blood glucose testing can reveal elevated levels that prompt further investigation for cortisol excess. Monitoring glucose helps track treatment success as cortisol levels return to normal.
High cortisol directly suppresses the production and survival of eosinophils, a type of white blood cell involved in immune responses. Eosinophil counts below 100 cells per microliter are common in Cushing Syndrome. This drop happens because cortisol interferes with the bone marrow's ability to make these cells. Low eosinophils combined with clinical signs of high cortisol support the diagnosis.
Recovery time varies based on how long you had high cortisol and which treatment you received. After surgery to remove a tumor, cortisol levels may normalize within weeks, but physical changes take longer to reverse. Weight loss, skin healing, and muscle strength often improve over 6 to 12 months. Some effects like bone loss or diabetes may require ongoing management even after cortisol returns to normal.
Lifestyle changes support medical treatment but cannot cure Cushing Syndrome alone. Eating a balanced diet low in sugar and sodium helps manage blood glucose and blood pressure. Weight-bearing exercise protects bone health and rebuilds muscle strength. Getting adequate sleep and managing stress improve mood and energy levels. These habits work best alongside medical treatments that address the root cause of excess cortisol.
Most cases of Cushing Syndrome are not inherited and happen randomly. However, rare genetic conditions like Multiple Endocrine Neoplasia type 1 or McCune-Albright syndrome increase the risk of tumors that cause cortisol excess. If you have a family history of these conditions, genetic testing and regular screening may be recommended. Medication-induced Cushing Syndrome has no genetic component.
Untreated Cushing Syndrome leads to type 2 diabetes, high blood pressure, heart disease, stroke, and blood clots. Bones become weak and prone to fractures due to calcium loss. Infections occur more frequently because high cortisol suppresses immune function. Mental health problems including severe depression and cognitive decline are common. Early treatment prevents or reduces the severity of these complications.
Testing frequency depends on your treatment stage and overall health. During initial diagnosis, you may need multiple tests within weeks. After starting treatment, blood work every few months helps monitor glucose, electrolytes, and signs of cortisol normalization. Once your condition stabilizes, testing every 6 months or annually tracks long-term health. Your doctor will create a personalized monitoring schedule based on your specific situation.
You cannot always prevent medication-induced Cushing Syndrome when corticosteroids are medically necessary. Work closely with your doctor to use the lowest effective dose for the shortest time possible. Never stop corticosteroids suddenly, as this can be dangerous. Ask about non-steroidal alternatives for your condition if available. Regular blood tests can detect early signs of cortisol excess so your treatment plan can be adjusted promptly.