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by Badash M

Cushing's Syndrome

(Cushing's Disease; Hypercortisolism)

Definition

Cushing's syndrome is a hormone disorder. Cortisol, in normal doses, helps the body manage stress and infection. However, high levels over a long period of time can cause several health problems.

Causes

Cushing's syndrome is caused by extended exposure to a hormone called cortisol. Prolonged or excess exposure to cortisol may be caused by:
  • Long-term use of corticosteroid hormones, such as cortisone or prednisone
  • Excess production of cortisol by:
    • Tumor or abnormality of the adrenal gland.
    • Tumor or abnormality of the pituitary gland. In the case of a pituitary tumor, it is called Cushing's disease
    • Rarely, tumors of the lung, thyroid, kidney, pancreas, or thymus gland.
Pituitary and Adrenal Glands
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Risk Factors

Factors that may increase your chance of Cushing's syndrome include:

Symptoms

Cushing's syndrome may cause:
  • Weight gain of the upper body and trunk
  • Rounded face
  • Severe fatigue or muscle weakness
  • Easily bruised, thinner skin
  • Purple stretch marks
  • Excess hair growth or acne in women
  • Menstrual disorders, especially infrequent or absent periods
  • Reduced fertility and interest in sex
  • Personality changes or mood swings
  • Bone loss—osteoporosis

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Tests may be done to determine the level of cortisol and find a cause.
Tests for cortisol levels may include:
  • 24-hour urinary free cortisol level
  • Late-evening cortisol saliva/blood level
  • Dexamethasone suppression test
Tests to determine the cause of Cushing's syndrome may include:
  • Blood test for adrenocorticotropin hormone (ACTH) level
  • High-dose dexamethasone suppression test
Imaging tests evaluate the pituitary and adrenal glands, and other internal structures. These may include:

Treatment

Treatment of Cushing's syndrome depends on the cause. Talk with your doctor about the best treatment plan for you. Options include:
  • Surgical removal of tumor
  • Surgical removal of part, all, or both adrenal glands
  • Radiation therapy for some persistent tumors
  • Gradual withdrawal of cortisone-type drugs under close medical supervision
  • Drugs that decrease cortisol production or block the functioning of other adrenal products

Prevention

Work with your doctor to keep your use of corticosteroid drugs to a minimum.

RESOURCES

Cushing's Support and Research Foundation
http://www.CSRF.net
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca
The College of Family Physicians of Canada
http://www.cfpc.ca

References

Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinolo Metabo. 2003;88(12):5593-5602.
Cushing disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated July 31, 2015. Accessed February 17, 2016.
Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.niddk.nih.gov/health-information/health-topics/endocrine/cushings-syndrome/Pages/fact-sheet.aspx. Updated April 2012. Accessed February 17, 2016.
Diez JJ, Iglesias P. Pharmacological therapy of Cushing’s syndrome: drugs and indications. Mini Rev Med Chem. 2007;7(5):467-480.
Kirk LF Jr, Hash RB, Katner HP, Jones T. Cushing's disease: clinical manifestations and diagnostic evaluation. Am Fam Physician. 2000;62(5):1119-1127.
Tritos NA, Biller BM, Swearingen B. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279-289.
Makras P, Toloumis G, Papadogias D, Kaltsas GA, Besser M. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones. 2006;5(4):231-250.

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