What are the other Names for this Condition? (Also known as/Synonyms)

• Cushing's Syndrome
• Hypercortisolism

What is Cushing Syndrome? (Definition/Background Information)

• Cushing Syndrome is an adrenal gland disorder caused by high levels of glucocorticoid hormones in the body. Adrenal glands are small glands situated on the upper poles of both kidneys
• In this disorder, high levels of cortisol are detected in the affected individual. Many factors could contribute to the high levels of cortisol, such as long-term use of steroid medications and increased adrenocorticotropic hormone (ACTH) synthesis by the pituitary gland owing to a tumor in the pituitary gland. The ACTH stimulates and regulates the adrenal gland functions
• Long-term use of steroids, obesity, and having conditions such as type-2 diabetes, are considered to be some risk factors for developing Cushing Syndrome
• This condition is reported to be relatively rare, affecting about 13 individuals per million. Although both genders are affected, women are found to be more susceptible to Cushing’s Syndrome
• Some common signs and symptoms of this disorder include skin thinning, increased blood pressure, increased blood glucose level, easy bruising, and weak muscles and bones. Potential complications of Cushing Syndrome include vulnerability to infections, osteoporosis, hypertension, and a decrease in muscle mass
• The treatment of Cushing Syndrome is dependent upon the cause of increased cortisol levels. If the cause is a tumor, different therapies, such as surgery and/or radiation, as well as cortisol replacement therapy are recommended to combat the same. If the use of steroids is the cause, reducing the dosage in due course of time may be presented as a treatment option
• When the condition is caused by prolonged steroid use, it is potentially possible to delay the onset of Cushing Syndrome by discontinuing the same. An early and effective treatment generally results in good prognosis

Who gets Cushing Syndrome? (Age and Sex Distribution)

• Cushing Syndrome is a relatively rare condition; the estimated occurrence is about 13 individuals per million population
• Most commonly, adults aged 20-50 years are reported to be affected by the condition
• Although the disorder can affect both genders, women are more prone to Cushing Syndrome than men
• All racial and ethnic groups are at risk and no specific predilection is observed

What are the Risk Factors for Cushing Syndrome? (Predisposing Factors)

Some risk factors associated with Cushing Syndrome include:

• Obesity
• Type II diabetes
• Depression
• High blood pressure
• Long-term use of steroids

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cushing Syndrome? (Etiology)

Cushing Syndrome may ensue as a result of increased presence of cortisol in the body. Several reasons can lead to this excess level including:

• Long-term use of steroid medications such as prednisone and dexamethasone (common cause)
• Increased synthesis of cortisol as a result of
  • Adrenal tumor (either benign or cancerous)
  • Pituitary adenoma (small, non-cancerous tumor)
  • Production of ACTH at another location, other than in the pituitary (such as due to lung cancer)

What are the Signs and Symptoms of Cushing Syndrome?

Some commonly reported signs and symptoms of Cushing Syndrome include:

• Skin thinning; easily bruised skin
• Purple/pink stretch marks on the thighs, abdomen, neck, and face
• Fatty hump between shoulders and neck; upper body obesity
• Increased blood pressure
• Increased blood glucose levels
• Intense fatigue, weakened muscles
• Slowed growth in children
• Irritability
• Round face
• Weak bones; thin arms and legs relative to rest of body

Gender specific signs and symptoms of Cushing Syndrome may include:

• In women:
  • Irregular menstrual period
  • Excess hair growth on face, chest, neck, abdomen, and thighs
• In men:
  • Erectile dysfunction
  • Decreased sex drive
  • Diminished fertility

How is Cushing Syndrome Diagnosed?

For an accurate diagnosis of Cushing Syndrome, a healthcare professional might require information from the following exams and tests:

• A complete evaluation of medical history, along with a thorough physical examination
• Common tests to check for the syndrome or its complications may include:
  • Cortisol levels in blood, saliva
  • 24-hour urinary free cortisol test - to measure the amount of cortisol in urine
  • Blood glucose levels
  • Low-dose and high-dose dexamethasone suppression tests
  • Potassium levels in blood
  • Cholesterol
  • Bone density
  • Level of ACTH; ACTH stimulation test
  • Petrosal sinus sampling to differentiate between Cushing’s disease and Cushing Syndrome
• Imaging tests that may include:
  • Abdominal CT scan
  • Pituitary MRI scan

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cushing Syndrome?

Some potential complications caused by Cushing Syndrome include:

• Hypertension
• Vulnerability to infection causing persistent signs and symptoms
• Diabetes
• Osteoporosis leading to weak and porous bones
• Loss of muscle mass

How is Cushing Syndrome Treated?

The treatment for Cushing Syndrome depends on the cause of increased cortisol levels in the body:

• When increased levels are caused by the use of steroids, the disorder is treated by slowly decreasing the medicine use
• When caused by adrenal or pituitary tumor, the treatment options may include
  • Surgery to remove the tumor
  • Radiation therapy in some cases
  • Cortisol replacement therapy after removal of the tumor
  • Medicines to block the release of hormone (if the tumor cannot be removed)

How can Cushing Syndrome be Prevented?

• Cushing Syndrome typically cannot be prevented, if the presence of tumors is the cause of the disorder
• However, when long-term steroid use is the cause, limiting steroid intake can potentially help delay disease onset

What is the Prognosis of Cushing Syndrome? (Outcomes/Resolutions)

• Cushing Syndrome, with successful diagnosis and treatment, is generally associated with a good prognosis
• Many individuals are able to stop cortisol replacement therapy in less than 1 or 2 years; although, some individuals may have to continue therapy for the remainder of one’s life

Additional and Relevant Useful Information for Cushing Syndrome:

Ectopic Cushing Syndrome is caused by the production of adrenocorticotropic hormone (ACTH) by a tumor outside the pituitary gland.