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Cushing’s Syndrome

What is Cushing’s Syndrome?

Cushing’s syndrome occurs when there is an excess of cortisol hormone in the blood. Cortisol is also called the “stress hormone” since it helps the body respond to stress. Cortisol also helps to regulate blood glucose, reduce inflammation, and maintain blood pressure. Cortisol is creating in the adrenal glands, which are two small glands that sit on top of both of your kidneys. This condition is most common in females than in males. There are two types of Cushing’s syndrome. Exogenous which is caused by factors outside the body or endogenous caused by something inside the body. The most common type of exogenous Cushing’s syndrome is caused by taking corticosteroids such as prednisone. Endogenous Cushing’s syndrome is usually caused by cortisol-secreting tumors located either in the adrenal glands or the pituitary gland. When the condition is caused by a pituitary tumor, then it is called Cushing’s disease. 

What are the symptoms of Cushing’s Syndrome?

  • Weight gain
  • Rounded face
  • High blood sugar
  • High blood pressure
  • Osteoporosis 
  • Skin that bruises easily
  • Purple stretch marks on abdomen or underarms
  • Increased facial hair in women
  • Fatty hump between the shoulders
  • Weak muscles

What are the complications of Cushing’s Syndrome?

  • Blood clots in the legs
  • Depression or mood swings 
  • Insulin resistance and/or prediabetes
  • Infections
  • Heart attack and stroke
  • Hypertension

How is Cushing’s Syndrome diagnosed?

Diagnosis is based on physical exam, history, and laboratory test. It is important for your medical practitioner to know if you are or have taken corticosteroids recently. The following test can be ordered:

  • 24-hour urine free-cortisol test: you collect your urine for 24 hours and then your provider sends it to a lab. If the cortisol level is higher than normal then it suggests Cushing’s syndrome. 
  • Late-night salivary cortisol test: since cortisol usually drops after falling asleep, your saliva is measured in the late evening for it. If high, then it’s suggestive of this condition
  • Low-dose dexamethasone suppression test (LDDST): a low dose of dexamethasone, a steroid, is given late at night. Then, your blood will be drawn the next day early in the morning. Usually, cortisol levels should drop after a steroid is given; therefore if levels don’t drop then it is suggestive of Cushing’s syndrome.  
  • Measure ACTH levels: if these levels are low, then there might be an adrenal tumor.  If ACTH levels are normal or high then the condition might be caused by a pituitary tumor. 

What are the differential diagnoses of Cushing’s Syndrome?

  • Diabetes mellitus
  • Obesity due to other causes
  • Primary hyperaldosteronism 
  • Striae distensae 

How is Cushing’s Syndrome treated?

The treatment of this condition is based on the cause of it. If it’s caused by taking corticosteroid medications, then your provider will start lowering the dose until discontinuing it completely and switch you to a different medication. If a pituitary or adrenal tumors are present, then the best treatment is removing the tumor. After the pituitary gland is removed, there is going to be a deficit of ACTH which stimulates the adrenals to produce cortisol, since your body still needs this hormone. Therefore, corticosteroids are given for a short period of time to stimulate the adrenal glands. For more information about Cushing’s disease, please visit this website.

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