Cushing's Syndrome
What is Cushing's syndrome?
Cushing's syndrome is a disorder that happens when your body is exposed to high levels of the hormone cortisol for too long. Cortisol is often called the stress hormone. It helps control blood sugar, reduce inflammation, and manage how your body uses fats, proteins, and carbs. While cortisol is essential for health, too much of it causes serious problems.
The condition can develop from taking corticosteroid medications for a long time, such as prednisone. It can also happen when your body produces too much cortisol on its own. This might occur because of tumors in the pituitary gland, adrenal glands, or other parts of the body. When a pituitary tumor causes the problem, doctors call it Cushing's disease, which is a specific type of Cushing's syndrome.
Without treatment, Cushing's syndrome can lead to high blood pressure, bone loss, diabetes, and other health issues. The good news is that testing can identify the condition early. Blood tests that measure ACTH and cortisol levels help doctors understand what is causing your symptoms and guide the right treatment approach.
Symptoms
- Weight gain, especially around the midsection and upper back
- A rounded face, sometimes called moon face
- A fatty hump between the shoulders, known as a buffalo hump
- Purple or pink stretch marks on the abdomen, thighs, breasts, or arms
- Thin skin that bruises easily
- Slow healing of cuts, infections, and insect bites
- Acne and facial hair growth in women
- Irregular or absent menstrual periods in women
- Decreased sex drive and erectile dysfunction in men
- Fatigue and muscle weakness
- Mood changes, including anxiety, irritability, or depression
- High blood pressure and high blood sugar
Some people notice only a few of these symptoms at first. The signs often develop slowly over months or years, which can make the condition hard to recognize early on.
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Causes and risk factors
Cushing's syndrome has two main causes. The first is taking corticosteroid medications for conditions like asthma, rheumatoid arthritis, or lupus. These drugs are similar to cortisol, and long-term use at high doses can lead to the syndrome. The second cause is when your body makes too much cortisol naturally. This usually happens because of tumors in the pituitary gland, adrenal glands, or rarely in the lungs or pancreas.
Pituitary tumors are the most common internal cause, accounting for about 70 percent of cases not related to medication. These tumors produce too much ACTH, a hormone that tells your adrenal glands to make cortisol. Adrenal gland tumors can also produce excess cortisol directly. Risk factors include being between ages 20 and 50, being female, and having a family history of endocrine tumors. Obesity and poorly controlled diabetes can make symptoms worse but do not directly cause the syndrome.
How it's diagnosed
Diagnosing Cushing's syndrome requires blood tests, urine tests, and sometimes imaging studies. Your doctor will start by measuring cortisol and ACTH levels in your blood. These tests help determine whether your body is producing too much cortisol and whether ACTH levels are driving the problem. High cortisol with high ACTH suggests a pituitary tumor, while high cortisol with low ACTH points to an adrenal issue.
Rite Aid offers ACTH and cortisol testing as an add-on to help you monitor hormone levels that relate to Cushing's syndrome. You can get tested at any Quest Diagnostics location near you. Additional tests like a 24-hour urine collection or late-night saliva test may also be needed. Your doctor might order imaging scans of your pituitary or adrenal glands to look for tumors once blood tests suggest the diagnosis.
Treatment options
- Reducing or stopping corticosteroid medications under medical supervision
- Surgery to remove tumors in the pituitary gland, adrenal glands, or elsewhere
- Radiation therapy if surgery is not possible or does not fully remove the tumor
- Medications that block cortisol production, such as ketoconazole, metyrapone, or mitotane
- Medications that block the effects of cortisol on tissues, like mifepristone
- Eating a balanced diet low in sodium and rich in calcium and vitamin D to protect bones
- Staying physically active to maintain muscle strength and bone density
- Managing blood sugar and blood pressure through diet, exercise, and medication if needed
- Working with an endocrinologist who specializes in hormone disorders
- Regular follow-up testing to monitor cortisol levels after treatment
Need testing for Cushing's syndrome? Add it to your panel.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
Cushing's syndrome is the general term for any condition that causes too much cortisol in the body. Cushing's disease is a specific type of Cushing's syndrome caused by a pituitary gland tumor that produces excess ACTH. All cases of Cushing's disease are Cushing's syndrome, but not all Cushing's syndrome cases are Cushing's disease.
Cushing's syndrome does not go away on its own without treatment. If it is caused by medication, symptoms may improve after you stop or reduce the drug under medical supervision. If it is caused by a tumor, you will need surgery, radiation, or medication to address the root cause.
Recovery time varies based on the cause and treatment. After successful surgery to remove a tumor, cortisol levels can return to normal within weeks to months. However, some symptoms like weight gain and muscle weakness may take a year or longer to fully improve. Your doctor will monitor your progress with regular blood tests.
Untreated Cushing's syndrome can lead to serious complications including type 2 diabetes, high blood pressure, heart disease, osteoporosis, frequent infections, and blood clots. It can also cause significant mental health issues like depression and anxiety. Early diagnosis and treatment are important to prevent these outcomes.
No, everyday stress does not cause Cushing's syndrome. While stress does raise cortisol levels temporarily, this is a normal response that helps your body cope. Cushing's syndrome requires prolonged exposure to abnormally high cortisol levels, usually from medication or a tumor.
Doctors use blood tests to measure cortisol and ACTH levels. High cortisol with high ACTH suggests a pituitary tumor is driving cortisol production. High cortisol with low ACTH indicates the adrenal glands or a tumor elsewhere is making too much cortisol directly. Additional tests like 24-hour urine cortisol or late-night saliva cortisol may also be ordered.
Most cases of Cushing's syndrome are not inherited. However, rare genetic conditions like multiple endocrine neoplasia type 1 can increase the risk of developing tumors that cause the syndrome. If you have a family history of endocrine tumors, talk to your doctor about screening.
You cannot prevent Cushing's syndrome caused by tumors. However, you can reduce your risk of medication-induced Cushing's syndrome by using the lowest effective dose of corticosteroids for the shortest time possible. Always work with your doctor when taking these medications and never stop them suddenly.
Cushing's syndrome is rare, affecting about 10 to 15 people per million each year. It is more common in women than men and usually occurs between ages 20 and 50. Most cases are caused by long-term use of corticosteroid medications.
It depends on the cause and treatment outcome. If surgery successfully removes the tumor and your body resumes normal cortisol production, you may not need ongoing treatment. However, some people need lifelong hormone replacement therapy if their adrenal or pituitary glands are damaged. Regular monitoring with blood tests is important even after successful treatment.