Cushing syndrome, or hypercortisolism, occurs due to abnormally high levels of the hormone cortisol. This can happen for a variety of reasons. Show
In most cases, getting treatment can help you manage your cortisol levels. The most common symptoms of this condition are:
In addition to the common symptoms above, there are other symptoms that may sometimes be observed in people with Cushing syndrome. These can include:
Cushing syndrome in childrenChildren can have Cushing syndrome, too, although they develop it less frequently than adults. According to a 2019 review, about 10 percent of new Cushing syndrome cases each year occur in children. In addition to the symptoms above, children with Cushing syndrome may also have:
Cushing syndrome in womenCushing syndrome is more prevalent in women than in men. According to the National Institutes of Health (NIH), three times as many women develop Cushing syndrome compared to men. Women with Cushing syndrome may develop extra facial and body hair. This most often occurs on the:
Additionally, women with Cushing syndrome may also experience irregular menstruation. In some cases, menstruation is absent altogether. Untreated Cushing syndrome in women can lead to difficulties becoming pregnant. Cushing syndrome in menAs is the case with women and children, men with Cushing syndrome can also experience additional symptoms. Men with Cushing syndrome may have:
Cushing syndrome is caused by an excess of the hormone cortisol. Your adrenal glands produce cortisol. Cortisol helps with a number of your body’s functions, including:
Your body may produce high levels of cortisol for a variety of reasons, including:
CorticosteroidsThe most common cause of Cushing syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. Healthcare professionals can prescribe these to treat inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ. High doses of injectable steroids for the treatment of back pain can also cause Cushing 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. The one caveat is prolonged topical steroid use in children. This prolonged use has been connected to Cushing syndrome. TumorsSeveral kinds of tumors can also lead to a higher production of cortisol. Some of these include:
Cushing syndrome vs. Cushing diseaseIf Cushing syndrome is caused by the pituitary gland overproducing ACTH which in turn becomes cortisol, it’s called Cushing disease. As with Cushing syndrome, Cushing disease affects more women than men. The main risk factor for developing Cushing syndrome is taking high-dose corticosteroids over a long period of time. If your doctor has prescribed corticosteroids to treat a health condition, ask them about the dosage and how long you’ll be taking them. Other risk factors can include:
Some cases of Cushing syndrome are due to tumor formation. Although there can be a genetic predisposition to develop endocrine tumors (familial Cushing syndrome), there’s no way to prevent tumors from forming. Cushing syndrome can be particularly difficult to diagnose. This is because many of the symptoms, like weight gain or fatigue, can have other causes. Additionally, Cushing syndrome itself can have many different causes. A healthcare professional will review your medical history. They’ll ask questions about symptoms, any health conditions you may have, and any medications you’re taking. They’ll also perform a physical exam where they’ll look for signs like a bump between your shoulders, stretch marks, and bruises. Next, they may order lab tests, including:
If you don’t already have an endocrinologist, you can browse doctors in your area through the Healthline FindCare tool. Diagnosing the cause of Cushing syndromeAfter you receive the diagnosis of Cushing syndrome, your doctor must still determine the cause of the excess cortisol production. Tests to help determine the cause may include:
The overall goal of Cushing syndrome treatment is to lower the levels of cortisol in your body. This can be accomplished in several ways. The treatment that you receive will depend on what’s causing your condition. Your doctor may prescribe a medication to help manage cortisol levels. Some medications decrease cortisol production in the adrenal glands or decrease ACTH production in the pituitary gland. Other medications block the effect of cortisol on your tissues. Examples include:
If you use corticosteroids, a change in medication or dosage may be necessary. Don’t attempt to change the dosage yourself. You should do this under close medical supervision. Pituitary tumorsThe most common type of treatment for pituitary tumors is surgery. The surgeon will go in through a nostril or an opening made below the upper lip to remove the tumor. When done correctly, this surgery has a 90 percent success rate. After the surgery, your body won’t make enough ACTH initially, so you will likely be prescribed cortisol medication for months to years. If surgery is not possible, radiation therapy may be an option. Ectopic ACTH-producing tumorsLike pituitary tumors, surgery is typically the first option for ectopic tumors. If surgery doesn’t work or isn’t an option, chemotherapy, radiation, and other cancer treatments may be able to help shrink the tumor. Medications to reduce cortisol levels may also be part of your treatment plan. One of the last treatment options is the removal of the adrenal glands. Adrenal tumorsSurgery to remove the adrenal gland with the tumor is the first line of treatment for adrenal tumors. In severe cases, it’s possible that both adrenal glands will have to be removed. In this instance, you may need to take medication for life to replace the hormones that adrenal glands produce, including cortisol. Although certain lifestyle changes like focusing on your diet won’t cure your condition, they can help to keep your cortisol levels from rising even more or help to prevent complications. Lifestyle tips for those with Cushing syndrome include:
Cushing syndrome involves the release of too much cortisol in the body. There are a variety of different causes of Cushing syndrome, from the long-term use of steroid medication to tumors on the adrenal glands. The sooner you begin treatment for Cushing syndrome, the better the expected outcome. It’s important to note that your individual outlook depends on the specific cause and treatment you receive. It may take some time for your symptoms to improve. Be sure to ask a healthcare professional for healthy dietary guidelines, keep follow-up appointments, and increase your activity level slowly. Support groups can help you cope with Cushing syndrome. Your local hospital or doctor can provide you with information about groups that meet in your area. What is the diagnostic test for Cushing syndrome?The 24-hour urinary cortisol test measures the amount of cortisol being produced within the urine over the course of an entire day. Levels higher than 50-100 micrograms per day in an adult suggest the presence of Cushing's syndrome.
What are the three tests used to diagnose Cushing's syndrome?Three first-line diagnostic tests are currently used to screen for CS: measurement of free cortisol in 24-hour urine (UFC), cortisol suppressibility by low doses of dexamethasone (DST), and assessment of cortisol circadian rhythm using late-night serum and/or salivary cortisol.
Which blood tests are performed for the patient with Cushing's syndrome?Low-Dose Dexamethasone Suppression test
This is the concept behind the dexamethasone suppression test and it is a very reliable test to diagnose Cushing syndrome, and quite straightforward to perform. Thus, it is often the #1 screening test for Cushing syndrome.
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