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Cushing's syndrome

Not to be confused with Cushing's triad, which is due to increased intracranial pressure.
This article is about the disease in humans. For the disease in animals, see Cushing's syndrome (veterinary).
Cushing's syndrome
Other namesHypercortisolism, Itsenko-Cushing syndrome, hyperadrenocorticism
Person's facial appearance 3 months after treatment with inhaled fluticasone[1]
SpecialtyEndocrinology
SymptomsHigh blood pressure, abdominal obesity with thin arms and legs, reddish stretch marks, round face, often reddened due to facial plethora, fat lump between the shoulders, weak muscles, acne, fragile skin[2]
ComplicationsHigh blood pressure (hypertension), Type 2 diabetes, Frequent or unusual infections, Loss of muscle mass and strength, Bone loss (osteoporosis).[3]
Usual onset20–50 years[4]
CausesProlonged exposure to cortisol[4]
Diagnostic methodRequires a number of steps[5]
TreatmentBased on underlying cause[6]
PrognosisGenerally good with treatment[7]
Frequency2–3 per million people per year[8] (from 1/333,333 to 1/500,000 people)

Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol.[4][9][10] Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face due to facial plethora,[11] a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly.[12][2] Women may have more hair and irregular menstruation.[2] Occasionally there may be changes in mood, headaches, and a chronic feeling of tiredness.[2]

Cushing's syndrome is caused by either excessive cortisol-like medication, such as prednisone, or a tumor that either produces or results in the production of excessive cortisol by the adrenal glands.[13] Cases due to a pituitary adenoma are known as Cushing's disease, which is the second most common cause of Cushing's syndrome after medication.[4] A number of other tumors, often referred to as ectopic due to their placement outside the pituitary, may also cause Cushing's.[4][14] Some of these are associated with inherited disorders such as multiple endocrine neoplasia type 1 and Carney complex.[8] Diagnosis requires a number of steps.[5] The first step is to check the medications a person takes.[5] The second step is to measure levels of cortisol in the urine, saliva or in the blood after taking dexamethasone.[5] If this test is abnormal, the cortisol may be measured late at night.[5] If the cortisol remains high, a blood test for ACTH may be done.[5]

Most cases can be treated and cured.[7] If due to medications, these can often be slowly decreased if still required or slowly stopped.[6][15] If caused by a tumor, it may be treated by a combination of surgery, chemotherapy, and/or radiation.[6] If the pituitary was affected, other medications may be required to replace its lost function.[6] With treatment, life expectancy is usually normal.[7] Some, in whom surgery is unable to remove the entire tumor, have an increased risk of death.[16]

About two to three cases per million persons are caused overtly by a tumor.[8] It most commonly affects people who are 20 to 50 years of age.[4] Women are affected three times more often than men.[8] A mild degree of overproduction of cortisol without obvious symptoms, however, is more common.[17] Cushing's syndrome was first described by American neurosurgeon Harvey Cushing in 1932.[18] Cushing's syndrome may also occur in other animals including cats, dogs, and horses.[19][20]

  1. ^ Celik O, Niyazoglu M, Soylu H, Kadioglu P (August 2012). "Iatrogenic Cushing's syndrome with inhaled steroid plus antidepressant drugs". Multidisciplinary Respiratory Medicine. 7 (1): 26. doi:10.1186/2049-6958-7-26. PMC 3436715. PMID 22958272.
  2. ^ a b c d "What are the symptoms of Cushing's syndrome?". 2012-11-30. Archived from the original on 2 April 2015. Retrieved 16 March 2015.
  3. ^ "Cushing syndrome". mayoclinic.org. Mayo Clinic. Retrieved June 5, 2022.
  4. ^ a b c d e f "Cushing's Syndrome". National Endocrine and Metabolic Diseases Information Service (NEMDIS). July 2008. Archived from the original on 10 February 2015. Retrieved 16 March 2015.
  5. ^ a b c d e f "How do health care providers diagnose Cushing's syndrome?". 2012-11-30. Archived from the original on 2 April 2015. Retrieved 16 March 2015.
  6. ^ a b c d "What are the treatments for Cushing's syndrome?". 2012-11-30. Archived from the original on 2 April 2015. Retrieved 16 March 2015.
  7. ^ a b c "Is there a cure for Cushing's syndrome?". 2012-11-30. Archived from the original on 27 March 2015. Retrieved 16 March 2015.
  8. ^ a b c d "How many people are affected by or at risk for Cushing's syndrome?". 2012-11-30. Archived from the original on 2 April 2015. Retrieved 16 March 2015.
  9. ^ Forbis P (2005). Stedman's medical eponyms (2nd ed.). Baltimore, Md.: Lippincott Williams & Wilkins. p. 167. ISBN 9780781754439. Archived from the original on 2017-09-08.
  10. ^ Sharma ST, Nieman LK (June 2011). "Cushing's syndrome: all variants, detection, and treatment". Endocrinology and Metabolism Clinics of North America. 40 (2): 379–91, viii–ix. doi:10.1016/j.ecl.2011.01.006. PMC 3095520. PMID 21565673.
  11. ^ Afshari, A; Ardeshirpour, Y; Lodish, MB (October 2015). "Facial Plethora: Modern Technology for Quantifying an Ancient Clinical Sign and Its Use in Cushing Syndrome". The Journal of Clinical Endocrinology and Metabolism. 100 (10): 3928–33. doi:10.1210/jc.2015-2497. PMC 4596033. PMID 26301943.
  12. ^ Patel, Reema; Sherf, Sahar; Lai, Ngan Betty; Yu, Run (2022-11-01). "Exogenous Cushing Syndrome Caused by a "Herbal" Supplement". AACE Clinical Case Reports. 8 (6): 239–242. doi:10.1016/j.aace.2022.08.001. ISSN 2376-0605. PMC 9701910. PMID 36447831.
  13. ^ "What causes Cushing's syndrome?". 2012-11-30. Archived from the original on 2 April 2015. Retrieved 16 March 2015.
  14. ^ Nieman LK, Ilias I (December 2005). "Evaluation and treatment of Cushing's syndrome". The American Journal of Medicine. 118 (12): 1340–1346. doi:10.1016/j.amjmed.2005.01.059. PMID 16378774.
  15. ^ "Cushing syndrome - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2019-04-21.
  16. ^ Graversen D, Vestergaard P, Stochholm K, Gravholt CH, Jørgensen JO (April 2012). "Mortality in Cushing's syndrome: a systematic review and meta-analysis". European Journal of Internal Medicine. 23 (3): 278–282. doi:10.1016/j.ejim.2011.10.013. PMID 22385888.
  17. ^ Steffensen C, Bak AM, Rubeck KZ, Jørgensen JO (2010). "Epidemiology of Cushing's syndrome". Neuroendocrinology. 92 (Suppl 1): 1–5. doi:10.1159/000314297. PMID 20829610.
  18. ^ "Cushing Syndrome: Condition Information". 2012-11-30. Archived from the original on 2 April 2015. Retrieved 16 March 2015.
  19. ^ Etienne Cote (2014). Clinical Veterinary Advisor: Dogs and Cats (3 ed.). Elsevier Health Sciences. p. 502. ISBN 9780323240741. Archived from the original on 2017-09-08.
  20. ^ McCue PM (December 2002). "Equine Cushing's disease". The Veterinary Clinics of North America. Equine Practice. 18 (3): 533–43, viii. doi:10.1016/s0749-0739(02)00038-x. PMID 12516933.
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