What Is Cushing’s Syndrome?

Cushing's Syndrome is a condition that happens when the body produces excess cortisol hormones. Cortisol is known as "the stress hormone." Cushing's Syndrome gets its name from Harvey Cushing who first described the condition back in 1932. Cushing’s Syndrome is also known as hypercortisolism.

Types of Cushing’s Syndrome

There are two types of Cushing's Syndrome, one type known as Primary or Adrenal Cushing’s Syndrome and another type called Secondary or Pituitary Type Cushing’s Disease.

• Primary Cushing's Syndrome — This type of Cushing’s Syndrome is due to the overproduction of cortisol by your adrenal glands.
• Secondary Cushing's Disease — This type of Cushing's Disease is due to excessive production of cortisol by the pituitary gland.

Symptoms

There are various Cushing’s Syndrome symptoms. Some of the long-term symptoms are easily observed by doctors.

Typical signs of Cushing’s Syndrome:

• Muscle weakness
• Rounded face
• Weight increase
• High blood pressure
• Thinner legs
• Thinner arms
• Stretch marks
• Headaches
• Neck fat
• Humped back
• Fragile skin
• Bruises

Symptoms in Children:

• Obesity
• Slow growth

Symptoms in Women:

• Body hair growth
• Facial hair growth
• Irregular menstruation
• Absent menstruation

Symptoms in Men:

• Erectile dysfunction
• Reduced sex drive
• Lowered fertility

Causes

Cushing’s Syndrome is caused by a surplus of cortisol hormones. The most common Cushing's Syndrome causes are an over-exposure to cortisol, certain medications, and tumors.

Cushing’s Syndrome Causes:

• Overactive Adrenal Gland — High stress, too much exercise, poor nutrition, depression, and alcoholism can cause the adrenal glands to produce too much cortisol.
• Medication — High doses of corticosteroid medications and certain steroids can cause Cushing's Syndrome.
• Tumors — Adrenal and pituitary gland tumors can lead to Cushing's Syndrome. Risk for developing endocrine gland tumors can be genetically inherited from your family.
• Cushing's Disease — When the pituitary glands overproduce adrenocorticotropic hormone (ACTH), which turns into cortisol, the condition is called Cushing's Disease.

Diagnosis

The tests used to diagnose Cushing's Syndrome are also used to diagnose many other diseases.

Tests for Cushing's Syndrome diagnosis:

• Physical Examination — Your doctor will check for abnormalities in the shape and size of body parts such as hands or fingers. Your doctor will also examine your neck and back for irregular lumps or growths.
• 24-Hour Urine Collection — You collect a urine sample over a 24-hour period.
• Salivary Cortisol Test — This test examines a sample of saliva taken late at night.
• Supine Blood Pressure Test — This test is done while you are lying down with your feet elevated. It measures the pressure in both arms at rest, then again after a period of exercise or stress.
• Low-dose dexamethasone suppression test — This test measures the level of cortisol in your body. It also identifies how much cortisol is being made by the pituitary gland.
• Petrosal sinus sampling — This test helps identify if the cause of your Cushing's Syndrome is in the pituitary gland or elsewhere in your body.
• Corticotropin-releasing hormone (CRH) test — This test measures how much CRH is being secreted by the pituitary gland to stimulate the production of ACTH and cortisol.
• Imaging tests — Imaging tests such as X-rays, Magnetic Resonance Imaging (MRI), and computerized tomography (CT) allow your doctor to inspect your adrenal and pituitary glands for abnormalities.

Treatment

Cushing's Syndrome is treated with a combination of surgery, medications, and lifestyle changes.

Cushing’s Syndrome treatment options:

• Medications — Your doctor may prescribe medications to manage symptoms, regulate cortisol production, and hormone replacement. If your condition resulted from corticosteroid drugs, your doctor may ask you to slowly reduce use of this medication.
• Surgery — If a tumor or growth caused your condition, your doctor may perform surgery to remove the tumor.
• Cushing’s Syndrome Diet — This diet is designed to manage the symptoms of Cushing’s Syndrome.

The Cushing Syndrome diet is often needed for a short time following surgery or other treatment, but it may be necessary long-term if you have difficulty controlling your weight and blood sugar levels. The goal of the diet is to maintain normal blood glucose levels as well as reduce protein consumption. This lowers the stress on your liver and kidneys. The diet has four phases that progress from very restrictive to less restrictive.

Prognosis

The Cushing’s Syndrome prognosis depends on your general health, the cause of the condition, and the severity of symptoms. The majority of people with Cushing’s Syndrome can lead normal or near-normal lives.

If you or a loved one experiences any of the symptoms of Cushing’s Syndrome, an endocrinologist at Baptist Health may be able to help.