Cushing Syndrome

Cushing’s syndrome is an uncommon syndrome that happens when your body has too much of a hormone called cortisol. It is also called hypercortisolism. Cortisol is a steroid hormone commonly called the “stress hormone.” Your body releases extra cortisol during times of stress, helping out by:

• Increasing your heart rate.
• Increasing your blood pressure.
• Managing your blood glucose.
• Managing your respiration.
• Increasing your muscle tension.

Cortisol also helps by shutting down, temporarily, systems that your body doesn’t need during times of increased stress, such as digestion and reproduction.

Cortisol is essential to:

• Maintaining blood pressure.
• Regulating blood sugar.
• Reducing inflammation.
• Forming memories.
• Managing respiration.
• Balancing salt in your body.
• Transforming your food into energy.

The adrenal glands (two small glands on top of your kidneys), pituitary gland (in your brain), and the hypothalamus (the part of your brain above the pituitary gland) control cortisol levels.

The cortisol levels found in Cushing’s syndrome are typically caused by a medication or a tumor.

Causes

Cushing’s syndrome is caused by an excess of the hormone cortisol. Your adrenal glands produce cortisol.

It helps with a number of your body’s functions, including:

• regulating blood pressure and the cardiovascular system
• reducing the immune system’s inflammatory response
• converting carbohydrates, fats, and proteins into energy
• balancing the effects of insulin
• responding to stress

Your body may produce high levels of cortisol for a variety of reasons, including:

• high stress levels, including stress related to an acute illness, surgery, injury, or pregnancy, especially in the final trimester
• athletic training
• malnutrition
• alcoholism
• depression, panic disorders, or high levels of emotional stress

Corticosteroids

The most common cause of Cushing’s syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. Healthcare providers can prescribe these to treat inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ.

High doses of injectable steroids for treatment of back pain can also cause Cushing’s syndrome. However, lower dose steroids in the form of inhalants, such as those used for asthma, or creams, such as those prescribed for eczema, usually aren’t enough to cause the condition.

Tumors

Several kinds of tumors can also lead to a higher production of cortisol.

Some of these include:

• Pituitary gland tumors. The pituitary gland releases too much adrenocorticotropic hormone (ACTH), which stimulates cortisol production in the adrenal glands. This is called Cushing’s disease.
• Ectopic tumors. These are tumors outside of the pituitary that produce ACTH. They usually occur in the lung, pancreas, thyroid, or thymus gland.
• Adrenal gland abnormality or tumor. An adrenal abnormality or tumor can lead to irregular patterns of cortisol production, which can cause Cushing’s syndrome.
• Familial Cushing’s syndrome. Although Cushing’s syndrome isn’t typically inherited, it’s possible to have an inherited tendency to develop tumors of the endocrine glands.

Cushing’s disease

If Cushing’s syndrome is caused by the pituitary gland overproducing adrenocorticotropic hormone (ACTH) which in turn becomes cortisol, it’s called Cushing’s disease.

As with Cushing’s syndrome, Cushing’s disease affects more women than men.

 What’s the difference between Cushing syndrome and Cushing disease?

Both illnesses come from too much cortisol in the body.

In Cushing syndrome (also called Cushing’s syndrome), excess cortisol can come from outside or inside the body. For example, it can come from using corticosteroid medications, such as prednisone. Or it can come from a pituitary or adrenal tumor causing the body to make too much cortisol.

Cushing disease is a specific type of Cushing syndrome. It occurs when a pituitary tumor causes the body to make too much cortisol. Cushing disease is the most common form of endogenous (from the body) Cushing syndrome, and makes up about 70% of Cushing syndrome cases.

Signs and Symptoms:

The most common symptoms of this condition are:

• weight gain
• fatty deposits, especially in the midsection, the face (causing a round, moon-shaped face), and between the shoulders and the upper back (causing a buffalo hump)
• purple stretch marks on the breasts, arms, abdomen, and thighs
• thinning skin that bruises easily
• skin injuries that are slow to heal
• acne
• fatigue
• muscle weakness

In addition to the common symptoms above, there are other symptoms that may sometimes be observed in people with Cushing’s syndrome.

These can include:

• high blood sugar
• increased thirst
• increased urination
• osteoporosis
• high blood pressure (hypertension)
• a headache
• mood swings
• anxiety
• irritability
• depression
• an increased incidence of infections

In children

Children can have Cushing’s syndrome too, although they develop it less frequently than adults. According to a 2019 study, about 10 percent of new Cushing’s syndrome cases each year occur in children.

In addition to the symptoms above, children with Cushing’s syndrome may also have:

• obesity
• slower rate of growth
• high blood pressure (hypertension)

In women

Cushing’s syndrome is more prevalent in women than in men. According to the National Institutes of Health (NIH), three times as many women develop Cushing’s syndrome compared to men.

Women with Cushing’s syndrome may develop extra facial and body hair.

This most often occurs on the:

• face and neck
• chest
• abdomen
• thighs

Additionally, women with Cushing’s syndrome may also experience irregular menstruation. In some cases, menstruation is absent altogether. Untreated Cushing’s syndrome in women can lead to difficulties becoming pregnant.

In men

As is the case with women and children, men with Cushing’s syndrome can also experience some additional symptoms.

Men with Cushing’s syndrome may have:

• erectile dysfunction
• a loss of sexual interest
• decreased fertility