Cushing's Syndrome

What is Cushing's Syndrome?

Cushing's syndrome is a hormonal disorder that happens when your body is exposed to high levels of cortisol for too long. Cortisol is a hormone made by your adrenal glands, two small organs that sit on top of your kidneys. Your body needs cortisol to manage stress, control blood sugar, and regulate blood pressure. But too much cortisol throws your entire system out of balance.

This condition can develop slowly over months or even years. Many people don't realize something is wrong until multiple symptoms appear together. The excess cortisol affects nearly every organ system in your body, from your metabolism to your immune system.

Cushing's syndrome is rare, affecting about 10 to 15 people per million each year. It most often affects adults between ages 20 and 50. Women are three times more likely than men to develop this condition. Early detection through blood testing can help you address the root cause before serious complications develop.

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Symptoms

Weight gain, especially around the midsection and upper back
Round, red, full face often called moon face
Fatty hump between the shoulders, sometimes called buffalo hump
Purple or pink stretch marks on the abdomen, thighs, breasts, or arms
Thin, fragile skin that bruises easily
Slow healing of cuts, infections, and insect bites
Severe fatigue and muscle weakness
High blood pressure
High blood sugar or diabetes
Increased thirst and urination
Mood changes including anxiety, irritability, or depression
Irregular or absent menstrual periods in women
Decreased sex drive and fertility problems
Excess hair growth on face, neck, chest, and abdomen in women

Some people have only a few mild symptoms at first. Others develop many symptoms quickly. The severity depends on how high your cortisol levels are and how long they stay elevated.

Causes and risk factors

Cushing's syndrome has two main causes. Endogenous Cushing's syndrome happens when your body produces too much cortisol on its own. This can occur when tumors grow on your pituitary gland, adrenal glands, or rarely in other organs like the lungs or pancreas. The most common type is Cushing's disease, caused by a pituitary tumor that signals your adrenal glands to overproduce cortisol. Exogenous Cushing's syndrome is more common and happens when you take high doses of corticosteroid medications like prednisone, dexamethasone, or hydrocortisone for conditions such as asthma, rheumatoid arthritis, or lupus.

Risk factors include long-term use of corticosteroid medications, having a family history of endocrine tumors, being female, and being between ages 25 and 40. Chronic stress alone does not cause Cushing's syndrome, but it can worsen symptoms. People with poorly controlled diabetes or obesity may face delayed diagnosis because some symptoms overlap. Identifying the root cause is essential because treatment depends on whether the problem comes from medication, a tumor, or adrenal gland dysfunction.

How it's diagnosed

Diagnosing Cushing's syndrome starts with blood tests that measure your cortisol levels at different times of day. Cortisol normally follows a daily pattern, highest in the morning and lowest at night. People with Cushing's syndrome often have high cortisol levels all day and night. Your doctor may also check related hormones like DHEA, testosterone, insulin, and C-peptide to understand how excess cortisol is affecting your metabolism. Blood tests for potassium and carbon dioxide help identify complications like metabolic alkalosis and low potassium that often occur with this condition.

Rite Aid offers testing for cortisol and related biomarkers through our flagship panel at over 2,000 Quest Diagnostics locations nationwide. If initial blood tests suggest Cushing's syndrome, your doctor may order additional tests like a 24-hour urine cortisol test, late-night saliva cortisol test, or dexamethasone suppression test. Imaging studies such as MRI or CT scans help locate tumors on the pituitary or adrenal glands. Getting tested regularly helps catch hormone imbalances early when they are easier to address.

Treatment options

Stop or reduce corticosteroid medications under medical supervision if they are the cause
Surgery to remove tumors on the pituitary gland, adrenal glands, or other organs
Radiation therapy if surgery is not possible or does not remove all tumor tissue
Medications to block cortisol production such as ketoconazole, metyrapone, or mitotane
Medications to block cortisol effects such as mifepristone
Adrenal gland removal in severe cases, followed by lifelong hormone replacement
Eating a balanced diet low in sodium and sugar to manage blood pressure and blood sugar
Getting regular physical activity to maintain muscle strength and bone density
Taking calcium and vitamin D supplements to protect bone health
Managing stress through sleep, meditation, or counseling
Regular monitoring of blood pressure, blood sugar, and hormone levels

Frequently asked questions

Cushing's syndrome is the general term for any condition that causes high cortisol levels in your body. Cushing's disease is a specific type of Cushing's syndrome caused by a tumor on the pituitary gland. Cushing's disease accounts for about 70 percent of endogenous Cushing's syndrome cases. Both conditions require medical treatment but have different approaches depending on the underlying cause.

No, Cushing's syndrome does not go away without treatment. If caused by medication, it may resolve after you stop taking corticosteroids under medical supervision. If caused by a tumor, you need surgery, radiation, or medication to lower cortisol levels. Untreated Cushing's syndrome can lead to serious complications including heart disease, diabetes, osteoporosis, and infections.

Diagnosis can take several weeks to months because testing requires multiple steps. Your doctor needs to confirm high cortisol levels through blood, urine, or saliva tests done at different times. Additional tests help determine whether the cause is a tumor or medication. Imaging studies to locate tumors may add more time. Early testing is important because symptoms can worsen while waiting for a diagnosis.

Yes, weight gain happens even with a healthy diet because excess cortisol changes how your body stores fat. Cortisol causes fat to accumulate around your abdomen, face, and upper back while causing muscle loss in your arms and legs. It also increases appetite and cravings for high-calorie foods. Treating the underlying cause of high cortisol is necessary to reverse these metabolic changes.

No, everyday stress does not cause Cushing's syndrome. Stress temporarily raises cortisol levels, but Cushing's syndrome requires constant, severe elevation of cortisol over months or years. This level of cortisol excess comes from tumors or long-term medication use, not from work stress or life challenges. However, managing stress is still important for overall health and recovery from Cushing's syndrome.

Most symptoms improve gradually over 6 to 12 months after cortisol levels return to normal. Weight gain, high blood pressure, and high blood sugar usually get better first. Skin changes, muscle weakness, and bone loss take longer to improve. Some people need physical therapy to regain strength. You may need ongoing hormone replacement if your adrenal glands were removed or damaged during treatment.

If you have Cushing's syndrome, your doctor will recommend testing every 3 to 6 months during treatment to monitor cortisol levels. After successful treatment, you may need annual testing to watch for recurrence. People taking long-term corticosteroid medications should discuss baseline cortisol testing with their doctor. Regular monitoring helps catch changes early before symptoms return or worsen.

Yes, Cushing's syndrome often causes high blood sugar and diabetes. Excess cortisol makes your cells resistant to insulin, the hormone that controls blood sugar. It also signals your liver to produce more glucose. About 20 to 47 percent of people with Cushing's syndrome develop diabetes. Treating Cushing's syndrome usually improves blood sugar control, though some people need ongoing diabetes management.

Most cases of Cushing's syndrome are not inherited. However, rare genetic conditions like multiple endocrine neoplasia type 1 or Carney complex can increase your risk of developing tumors that cause Cushing's syndrome. If you have a family history of endocrine tumors, talk to your doctor about genetic testing. Most pituitary and adrenal tumors that cause Cushing's syndrome happen randomly without a family connection.

Untreated Cushing's syndrome leads to serious health problems including heart disease, stroke, blood clots, severe osteoporosis, kidney stones, and recurrent infections. High cortisol weakens your immune system and damages blood vessels. It also increases risk of depression and cognitive decline. Early diagnosis and treatment prevent these complications and improve quality of life.