Cushing syndrome is a disorder with physical and mental changes that result from having too much cortisol in the blood for a long period of time. Cortisol is a steroid hormone produced by the adrenal glands, located above the kidneys.

Overview and Symptoms

Cushing syndrome occurs when your body is exposed to high levels of the hormone cortisol for a long period of time, either by the body making too much of it or by taking oral corticosteroid medication.

The distinguishing signs of Cushing syndrome are a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes.

The symptoms of Cushing syndrome can depend on how much cortisol is in your body, but can include:

  • Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face and between the shoulders (buffalo hump)
  • Pink or purple stretch marks on the skin of the abdomen, thighs, breasts and arms
  • Thinning, fragile skin that bruises easily
  • Slow healing of cuts, insect bites and infections
  • Acne
  • Thicker or more visible body and facial hair (in women)
  • Irregular or absent menstrual periods (in women)
  • Decreased libido (in men)
  • Decreased fertility (in men)
  • Erectile dysfunction (in men)

Diagnosis

Cushing syndrome can be easy for your physician to diagnose if you have some of the more obvious symptoms, especially if you've been taking corticosteroid medication for a long time. However, your physician may perform the following tests:

  • Urine and blood test
  • Saliva test
  • Imaging, such as computerized tomography (CT) scans or magnetic resonance imaging (MRI)
  • Petrosal sinus sampling - blood samples taken from the petrosal sinuses — veins that drain the pituitary gland.

Treatment at BIDMC

Reducing Corticosteroid Use

If the cause of Cushing syndrome is from long-term use of corticosteroid medications, your doctor may be able to keep your Cushing syndrome symptoms under control by reducing the dosage over a period of time, while still adequately managing the condition for which you are taking the medication.

Surgery

If the cause of Cushing syndrome is a tumor, your doctor may recommend surgery. After the operation, you'll need to take cortisol replacement medications temporarily to provide your body with the correct amount of cortisol. This process can take up to a year or longer. In some instances, people with Cushing syndrome never experience a resumption of normal adrenal function; they then need lifelong replacement therapy.

Radiation Therapy

If the surgeon can't totally remove the tumor, he or she will usually prescribe radiation therapy to be used in conjunction with surgery. Additionally, radiation may be used for people who aren't suitable candidates for surgery.

Medications

Medications can be used to control cortisol production when surgery and radiation don't work, and they can also be used before surgery in people who have become very sick with Cushing syndrome. Doctors may recommend medication before surgery to improve signs and symptoms and minimize surgical risk. However, medications may not completely improve all of the symptoms.

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The division of Endocrinology, Diabetes and Metabolism provides expertise in a wide range of endocrine disorders, including pituitary, thyroid, and adrenal diseases, obesity, and diabetes.

Endocrinology, Diabetes and Metabolism