Cushing’s syndrome is a rare hormonal disorder caused by prolonged exposure to high levels of cortisol, a hormone produced by the adrenal glands that helps regulate blood pressure, blood sugar, and the body’s response to stress12. The condition can develop due to the body’s own overproduction of cortisol or from taking corticosteroid medications for extended periods.
Causes
The main causes of Cushing’s syndrome include:
- Prolonged use of corticosteroid medications (such as prednisone, hydrocortisone, or prednisolone), often prescribed for conditions like asthma, rheumatoid arthritis, and other inflammatory diseases.
- Pituitary gland tumors (Cushing’s disease), which cause the pituitary to release excess adrenocorticotropic hormone (ACTH), stimulating the adrenal glands to produce more cortisol.
- Adrenal gland tumors (benign or malignant), directly increasing cortisol production.
- Ectopic ACTH syndrome, where ACTH is produced by tumors outside the pituitary, such as certain lung cancers.
Symptoms
Symptoms of Cushing’s syndrome develop gradually and can vary, but common features include:
- Rapid weight gain, especially in the trunk, upper back, and face (leading to a “moon face” appearance)
- Fatty hump between the shoulders (“buffalo hump”)
- Thin arms and legs
- Purple or pink stretch marks (striae) on the abdomen, thighs, breasts, and arms
- Thinning, fragile skin that bruises easily
- Slow wound healing
- Muscle weakness, particularly in the upper arms and legs
- High blood pressure (hypertension)
- High blood sugar or development of type 2 diabetes
- Bone loss (osteoporosis)
- Increased risk of infections
- Mood changes, such as irritability, anxiety, and depression
- Fatigue and trouble concentrating
Additional symptoms in women:
- Irregular or absent menstrual periods
- Excess facial and body hair (hirsutism)
Additional symptoms in men:
- Decreased libido
- Erectile dysfunction
In children:
- Obesity and slowed growth
Diagnosis
Diagnosis involves several steps:
- Reviewing the patient’s medication history (to check for corticosteroid use)
- Measuring cortisol levels in urine, saliva, or blood (often after a dexamethasone suppression test)
- If cortisol remains high, additional tests may include ACTH measurement and imaging studies (MRI or CT scans) to locate possible tumors.
Treatment
Treatment depends on the underlying cause:
- Reducing or stopping corticosteroid medications if possible (under medical supervision).
- Surgical removal of tumors (pituitary, adrenal, or ectopic sources), which may be followed by radiation or chemotherapy if necessary.
- Medications to control cortisol production if surgery is not possible or as an adjunct to other treatments.
With appropriate treatment, most people can recover and have a normal life expectancy, although some symptoms may persist if not addressed early.
Epidemiology
Cushing’s syndrome is rare, affecting about 2–3 people per million per year. It is most common in adults aged 20–50 and occurs more frequently in women than men.
Summary:
Cushing’s syndrome is a rare disorder caused by prolonged high cortisol levels, most often due to corticosteroid medication or tumors affecting hormone production. Symptoms include weight gain (especially in the face and trunk), skin changes, muscle weakness, high blood pressure, and mood disturbances. Early diagnosis and treatment are crucial for a good prognosis.
Citations:
- https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310
- https://www.nhs.uk/conditions/cushings-syndrome/
- https://my.clevelandclinic.org/health/diseases/5497-cushing-syndrome
- https://en.wikipedia.org/wiki/Cushing’s_syndrome
- https://www.healthline.com/health/cushings-syndrome
- https://medlineplus.gov/ency/article/000410.htm
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/cushing-syndrome
- https://www.webmd.com/a-to-z-guides/cushing-syndrome
- https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/diagnosis-treatment/drc-20351314