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    Cushing syndrome

    Hypercortisolism

    Cushing syndrome is a disorder that occurs when your body is exposed to high levels of the hormone cortisol. It may also occur if you take too much cortisol or other steroid hormones.

    See also: Cushing's disease (pituitary Cushing's)

    Causes

    Cushing syndrome may be caused by taking too much corticosteroid medications, such as prednisone and prednisolone. These drugs are used to treat conditions such as asthma and rheumatoid arthritis.

    Other people develop Cushing syndrome because their bodies produce too much cortisol, a hormone normally made in the adrenal gland. Causes of too much cortisol are:

    • Cushing's disease, when the pituitary gland makes too much of the hormone ACTH. ACTH then signals the adrenal glands to produce cortisol. Tumor of the pituitary gland may cause this condition.
    • Tumor of the adrenal gland
    • Tumor elsewhere in the body that produces cortisol
    • Tumors elsewhere in the body that produce ACTH (such as the pancreas, lung, and thyroid)

    Symptoms

    Most people with Cushing syndrome will have:

    • Upper body obesity (above the waist) and thin arms and legs
    • Round, red, full face (moon face)
    • Slow growth rate in children

    Skin changes that are often seen:

    • Acne or skin infections
    • Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
    • Thin skin with easy bruising

    Muscle and bone changes include:

    • Backache, which occurs with routine activities
    • Bone pain or tenderness
    • Collection of fat between the shoulders (buffalo hump)
    • Rib and spine fractures (caused by thinning of the bones)
    • Weak muscles

    Women with Cushing syndrome often have:

    • Excess hair growth on the face, neck, chest, abdomen, and thighs
    • Menstrual cycle that becomes irregular or stops

    Men may have:

    • Decreased or no desire for sex
    • Impotence

    Other symptoms that may occur with this disease:

    • Mental changes, such as depression, anxiety, or changes in behavior
    • Fatigue
    • Headache
    • Increased thirst and urination

    Exams and Tests

    Blood sugar and white blood cell counts may be high. Potassium level may be low.

    Laboratory tests that may be done to diagnose Cushing syndrome and identify the cause are:

    • Serum cortisol levels
    • Salivary cortisol levels
    • Dexamethasone suppression test
    • 24-hour urine for cortisol and creatinine
    • ACTH level
    • ACTH (cosyntropin) stimulation test

    Tests to determine the cause or complications may include:

    • Abdominal CT
    • ACTH test
    • Pituitary MRI
    • Bone density, as measured by dual x-ray absorptiometry (DEXA)

    High cholesterol, including high triglycerides and low high-density lipoprotein (HDL) may also be present.

    Treatment

    Treatment depends on the cause.

    Cushing syndrome caused by corticosteroid use:

    • Slowly decrease the drug dose (if possible) under medical supervision.
    • If you cannot stop taking the medication because of disease, your high blood sugar, high cholesterol levels, and bone thinning or osteoporosis should be closely monitored.

    Cushing syndrome caused by a pituitary or a tumor that releases ACTH (Cushing's disease):

    • Surgery to remove the tumor
    • Radiation after removal of a pituitary tumor (in some cases)
    • You may need hydrocortisone (cortisol) replacement therapy after surgery, and possibly continued throughout your life

    Cushing syndrome due to an adrenal tumor or other tumors:

    • Surgery to remove the tumor
    • If the tumor cannot be removed, medications to help block the release of cortisol

    Outlook (Prognosis)

    Removing the tumor may lead to full recovery, but there is a chance that the condition will return.

    Survival for people with ectopic tumors depends on the tumor type. Untreated, Cushing syndrome can be life-threatening.

    Possible Complications

    • Diabetes
    • Enlargement of pituitary tumor
    • Fractures due to osteoporosis
    • High blood pressure
    • Kidney stones
    • Serious infections

    When to Contact a Medical Professional

    Call your health care provider if you have symptoms of Cushing syndrome.

    References

    Stewart PM, Krone NP. The adrenal cortex. In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 15.

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    • Endocrine glands

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      • Endocrine glands

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      A Closer Look

        Self Care

          Tests for Cushing syndrome

            Review Date: 12/11/2011

            Reviewed By: Nancy J. Rennart, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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