Cushing's Syndrome

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Overview

Cushing syndrome occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce too much cortisol.

Too much cortisol can cause some of the hallmark signs of Cushing syndrome — 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.

Treatments for Cushing syndrome can return your body's cortisol levels to normal and improve your symptoms. The earlier treatment begins, the better your chances for recovery.

Symptoms

Other possible signs and symptoms of Cushing syndrome

Severe fatigue.

Muscle weakness.

Depression, anxiety and irritability.

Loss of emotional control.

Cognitive difficulties.

New or worsened high blood pressure.

Headache.

Infections.

Causes

Too much cortisol causes Cushing’s syndrome. There may be many underlying causes of high cortisol levels, including:

  • Use of glucocorticoid medications. Glucocorticoid medications (for example, prednisone) are used to treat many autoimmune diseases, for example chronic asthma, rheumatoid arthritis, lupus, sarcoidosis and many other diseases that result in chronic inflammation. Chronic treatment with these medications causes “iatrogenic” Cushing’s syndrome. Iatrogenic refers to something that is caused by a medical treatment.
  • Pituitary tumors. Pituitary tumors that make too much ACTH (the hormone that tells the adrenal glands to make cortisol) cause eight out of 10 cases of Cushing's syndrome (excluding the cases of iatrogenic Cushing’s syndrome). This is called Cushing’s disease.
  • Adrenal cortical tumors. A tumor on the adrenal gland itself can make too much cortisol. These are usually benign.
  • Lung, pancreas, thyroid and thymus tumors. Tumors that develop outside of the pituitary gland can produce ACTH and this is called ectopic ACTH syndrome. These types of tumors are typically malignant. The most common type of these tumors is small cell lung cancer.

Risk factors

The main risk factor for developing Cushing syndrome is taking high-dose corticosteroids over a long period of time. If your doctor has prescribed corticosteroids to treat a health condition, ask them about the dosage and how long you’ll be taking them.

Other risk factors can include:

being labeled female at birth

your age

living with pituitary or adrenal tumors

Some cases of Cushing syndrome are due to tumor formation. Although there can be a genetic predisposition to develop endocrine tumors (familial Cushing syndrome), there’s no way to prevent tumors from forming.

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Complications

If you have Cushing syndrome, it’s important that it’s properly managed. If you don’t get treatment for it, Cushing syndrome can lead to a variety of potentially serious health complications.


These can include:


osteoporosis, which can increase your risk of bone fractures

muscle loss (atrophy) and weakness

high blood pressure (hypertension)

type 2 diabetes

frequent infections

heart attack or stroke

depression or anxiety

cognitive difficulties like trouble concentrating or problems with memory

enlargement of an existing tumor


Prevention

Cortisol is not your body's enemy, but too much of it can be. Have your healthcare provider monitor your cortisol levels closely if you're on glucocorticoids or steroids. Unfortunately, there's no way to prevent a tumor that causes Cushing's syndrome.The only way to prevent Cushing's syndrome caused by corticosteroid medication is to avoid taking this type of medication, if possible.