Cushing's Syndrome also known as hypercortisolism
is caused by prolonged exposure to elevated levels of either endogenous glucocorticoids
(Cortisol) or exogenous glucocorticoids
About two to three people per million are affected each year. It most commonly affects people who are 20 to 50 years of age. Women are affected three times more often than men.Cortisol
, commonly known as the stress hormone, is produced by the adrenal glands and helps with a number of your body’s functions, including: increasing blood pressure, reducing the immune system’s inflammatory response, increasing blood sugar and decreasing in bone calcium.Endogenous Cushing syndrome is due to the body's own overproduction of cortisol, this may be due to:
Exogenous Cushing syndrome can develop from taking glucocorticoid medications
- An ACTH-producing pituitary tumor (pituitary adenoma also know as Cushing's Disease). 70% of endogenous cases of Cushing Syndrome are caused by pituitary adenomas.
- Ectopic ACTH syndrome (tumors usually found in the lung, pancreas, thyroid, or thymus gland)
- Adrenal adenoma (a noncancerous tumor of the adrenal cortex)
- Adrenocortical carcinoma (a cancerous tumor of the adrenal cortex)
- Bilateral hyperplasia (benign, nodular enlargement of both adrenal glands).
such as prednisone in high doses over an extended period of time. Glucocorticoids are used for conditions such as asthma, rheumatoid arthritis, lupus, or after an organ transplant.
Signs and symptoms may include:
- High blood pressure
- Abdominal obesity but with thin arms and legs
- Pink or purple stretch marks (striae) on the skin of the abdomen
- A round red face (moon face)
- A fatty (buffalo) hump between your shoulders
- Weak muscles
- Weak bones
- Fragile skin that that bruises easily
- Cognitive difficulties
- Glucose intolerance that may lead to diabetes
- Anxiety and irritability
- Women may have more hair and irregular menstruation.
- Men with Cushing syndrome may experience decreased libido, decreased fertility and erectile dysfunction
- Children who have this condition are often obese and have a slowed rate of growth.
DiagnosisDiagnosis requires a number of steps. First step is checking the medications a person takes. The second step is measure levels of cortisol in the urine, saliva or in the blood after taking dexamethasone (dexamethasone suppression test). If this test is abnormal the cortisol may be measured late at night. If the cortisol remains high testing the blood for ACTH to determine if the pituitary is involved may be done.
Treatment will depend on what is causing the problem. If due to medications, these can often be slowly stopped. If caused by a tumor, surgical removal, radiation therapy or chemotherapy may be required. If cortisol production is very high, then cortisol blocking medications like Mifepristone can bu used to control symptoms.
With treatment, life expectancy is usually normal. Some in whom surgery is unable to remove the entire tumor have an increased risk of death.