Cushing's Syndrome: Know the Symptoms & Treatment

What is Cushing's syndrome?

Cushing's syndrome, also called hypercortisolism, is caused by unusually high levels of the hormone cortisol in the body.

Cortisol is a steroid hormone that helps with many of the body’s responses, including stress. If you have too much cortisol, it can cause excessive weight gain, stretch marks, and easy bruising. It can eventually lead to high blood pressure and diabetes.

There are three main ways your body can have too much cortisol. The most common cause is long-term use of cortisol-like glucocorticoids medications, such as for treating asthma.

Other rarer causes are having a small tumor in the pituitary gland. Or a small tumor in the adrenal gland. The tumors cause an increase in the production of cortisol.

Cushing's syndrome symptoms

Symptoms of Cushing’s are often subtle. This makes the condition hard to diagnose in the early stages.

Common symptoms include weight gain—usually around the waist, in the face, and on the back between the shoulder blades.

People may develop stretch marks, which are referred to as striae. Other symptoms include easy bruising and acne. Elevated blood pressure is also common.

Any of these symptoms alone is often common. And they can have many different causes. But all of them together could be a sign of Cushing’s syndrome.

Main symptoms

• Weight gain in specific places: midsection, face, in back area between shoulders
• Stretch marks
• Elevated blood pressure
• Acne, most commonly on the face
• Easy bruising
• Fatigue

Other symptoms you may have

• Increase in facial and body hair (in women)
• Irregular menstrual cycle (in women)
• Lower libido
• Osteoporosis (accelerated bone loss)
• Mood changes (depression, anxiety, irritability)
• Newly diagnosed type 2 diabetes

Causes of Cushing’s syndrome

Your body naturally makes the cortisol hormone. Some people need to take glucocorticoids medications (also known as steroids) over a long period of time to treat conditions like asthma or inflammatory bowel disease.

These steroids can interact with your body in a similar way that cortisol does. That causes an excess of cortisol or cortisol-like hormones, which leads to symptoms of Cushing’s.

The pituitary gland and adrenal glands play crucial roles in the development of Cushing's syndrome. The pituitary gland, a small organ at the base of the brain, produces adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol. In Cushing's syndrome, this delicate balance is disrupted. Tumors in the pituitary gland, known as pituitary adenomas, can cause an overproduction of ACTH, leading to excessive cortisol production by the adrenal glands. These pituitary tumors are responsible for approximately 70-80% of Cushing's syndrome cases, a condition specifically referred to as Cushing's disease. Alternatively, tumors in the adrenal glands themselves can directly produce excess cortisol, bypassing the pituitary gland's regulatory function. Understanding the interplay between these glands is crucial for diagnosing and treating Cushing's syndrome effectively.

Other causes are having a small tumor in the pituitary gland (called Cushing disease). The pituitary gland makes adrenocorticotropic hormone (ACTH), which in turn tells the adrenal glands to make cortisol. There can also be a small tumor in the adrenal gland. Both signal your adrenal gland to make too much natural cortisol.

Cushing’s syndrome treatment

Getting a correct diagnosis may take time. Often your doctor will order blood tests and urine tests first. Then, imaging, like an MRI.

But tumors can be very small and easily missed on an MRI. In rare circumstances, the veins inside the brain might be sampled for hormone levels to figure out the cause.

Treatment depends on the cause.

If it is from medications that your doctor has prescribed, you need to work with him or her on a plan to lower your dosage. Or to use an alternative.

If the high cortisol levels are related to a tumor, you’ll need surgery to remove it.

Surgery

If you have a tumor in your pituitary gland, a neurosurgeon will give you an MRI scan. Then, the surgeon will remove it using the natural opening of your nose. Since the tumor is usually very small and sometimes hard to find, sometimes you’ll need more treatment, like focused radiation or medications. These can help lower cortisol production.

If you have a tumor in the adrenal glands, located in the upper abdomen, a specialist in endocrine surgery will take an imaging scan to find it. Then, he or she will remove the tumor surgically.

Follow up

The side effects of having too much cortisol are the most harmful part of Cushing’s syndrome. Particularly high blood pressure and diabetes. You’ll want to monitor these conditions closely to prevent long-term health complications.

Prevention

The tumors that cause Cushing’s cannot be prevented. However, it’s important to try to avoid using prescription steroids long term.

Talk to your doctor about all medications you are taking, particularly steroids. There are steroid alternatives that could work, depending on your condition.