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Cushing's Syndrome

Alternative names: Hypercortisolism, Cushing's Disease

What is Cushing's syndrome?
What are the signs of Cushing's syndrome?
What causes Cushing's syndrome?
How does my doctor tell if I have Cushing's syndrome?
How is Cushing's syndrome treated?

What is Cushing's syndrome?

The adrenal glands are located on the top of your kidneys, and produce adrenaline, cortisol, aldosterone, and other steroid hormones that enable the body to respond to stress. Cushing's syndrome is a condition in which the adrenal glands produce too much cortisol. It is frequently caused by a benign (non-cancerous) tumor of the pituitary gland.

What are the signs of Cushing's syndrome?

Symptoms of this syndrome can include:

  • Weight gain in the upper body, especially around the face and neck
  • Reddening of the face, and/or acne
  • High blood pressure (hypertension)
  • Thinning of the skin, or skin that bruises easily
  • Loss of bone density (osteoporosis)
  • High blood sugar (hyperglycemia)
  • Thin arms and legs
  • Excess hair growth in women
  • Irregular or absent menstrual periods in female patients
  • Decreased fertility and reduced sex drive in male patients
  • Weakness and fatigue
  • In children, slow growth

What causes Cushing's syndrome?

The pituitary gland, which is located at the base of the brain, normally stimulates the adrenal glands to produce the cortisol your body needs to pump blood, digest food, and respond to stress. A non-cancerous tumor (adenoma) of the pituitary gland can overstimulate the adrenal glands and cause them to produce too much cortisol. This is the cause of Cushing's syndrome in most cases. The syndrome can also be caused by:

  • A non-cancerous tumor in the adrenal glands (adrenal adenoma)
  • Cancerous growths in the lungs, or in another organ, which stimulate the adrenal glands to produce cortisol
  • Long-term use of cortisone steroids, such as Prednisone

How does my doctor tell if I have Cushing's syndrome?

To diagnose Cushing's syndrome, your doctor may want to perform one or more of the following tests:

  • In a 24-hour urine collection test, the patient's urine is collected over a 24-hour period, and tested for the amount of cortisol in the urine. High cortisol levels suggest the patient may have Cushing's syndrome.
  • A dexamethasone suppression test can help a doctor learn whether the excess cortisol is caused by a pituitary tumor, or another cause. The doctor gives the patient dexamethasone, a synthetic version of cortisol, and checks the patient's urine to see how his or her body responds. Normally, a patient's cortisol levels will drop after taking dexamethasone. Responses to different levels of the synthetic hormone can tell what is causing the excess production of cortisol.
  • In a CRH stimulation test, patients are given a hormone that causes the pituitary gland to secrete a hormone that stimulates the adrenal glands to produce cortisol. The body's response to this hormone can determine what is causing the excess production of cortisol.
  • Computed tomography (CT) and magnetic resonance imaging (MRI) scans make images of the pituitary and/or adrenal glands, and can help your doctor check for enlargement or growths

How is Cushing's syndrome treated?

Treatment depends on what is causing the excess production of cortisol:

  • For a tumor of the pituitary gland (pituitary adenoma), a surgeon may perform a transsphenoidal adenomectomy. The surgeon uses a microscope and tiny instruments to remove the tumor. The surgery is done through a nostril, or through an opening made below the upper lip.
  • Adrenal adenomas (a tumor of the adrenal glands) can be removed by laparoscopic surgery. You will be under general anesthesia, unconscious and unable to feel any pain. The surgeon will make several short cuts in your abdomen, and pass a tiny video camera and surgical instruments through these incisions. The camera sends images from inside the body to a TV monitor. Guided by these images, the surgeon uses the surgical tools to remove the adrenal gland.
  • Cancer in the lungs or other organs is treated through surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of these treatments
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