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Cushing syndrome happens when your body is exposed to high levels of the hormone cortisol for an extended time and is sometimes referred to as hypercortisolism. It can be triggered by the consumption or intake of oral corticosteroid medication. The condition can also happen when your body makes too much cortisol on its own.
Excessive amounts of cortisol can create some of the trademark signs of Cushing syndrome — a rounded face, a fatty lump in-between your shoulders, and purple or pink or stretch marks across your skin. It can also appear due to high blood pressure, bone loss, and, on occasion, after the development of type 2 diabetes.
Treatments for Cushing syndrome can restore your body’s cortisol production levels to a healthy and noticeably improve your symptoms. The earlier you start your treatment plan, the higher your chances are for recovery.
The symptoms and signs of Cushing syndrome can differ based on the levels of additional cortisol within your body.
Typical signs and symptoms of Cushing syndrome include:
- Fatty tissue deposits, which cause weight gain, primarily around the midsection and upper back, in the face (moon-shaped facial structure), and between the shoulders (referred to as a buffalo hump)
- Pink or purple stretch marks (striae), sometimes redden streaks on the skin of the abdomen, breast, thighs, and arms
- Slow or prolonged healing of cuts, insect bites and infections
- Thinning, fragile skin that bruises easily
- Severe and chronic fatigue
- Depression, anxiety, and irritability
- Muscle weakness
- Loss of emotional control
- Cognitive difficulties
- New or worsened high blood pressure
- Bone loss, leading to fractures over time
- Heightened pigmentation of the skin
- Signs and symptoms in women with Cushing syndrome may undergo:
- Thicker and noticeably more hair on the body and facial hair (hirsutism)
- Irregular or absent menstrual periods
- Men’s Signs and symptoms for Cushing syndrome may differ, including the following:
- Decreased libido
- Erectile dysfunction
- Reduced fertility
- In children, reduced growth rate
When to See a Physician
Reach out your doctor if you have symptoms that may indicate Cushing syndrome, particularly if you’re taking corticosteroid drugs to treat a condition, such as arthritis, asthma, or inflammatory bowel disease.
Excessive levels of the cortisol hormone can cause Cushing syndrome. Cortisol, created in the adrenal glands, performs a variety of functions in your body.
For example, cortisol serves to regulate your blood pressure, lessens inflammation throughout the body, and keeps your heart and blood vessels working and performing naturally. Cortisol assists your body to respond to stress. It also controls the way you transform carbohydrates, (metabolize) proteins, and fats in your diet into available energy.
The function of Corticosteroid Medications
Cushing syndrome can be triggered by something outside of your body (exogenous Cushing syndrome). One instance is taking oral corticosteroid medications in high doses over an extensive period. These medications, such as prednisone, have identical results in the body.
Oral corticosteroids may be required to treat inflammatory diseases, such as lupus, rheumatoid arthritis, or asthma. It may also be useful in preventing your body from rejecting a transplanted organ. Due to the fact that the doses needed to treat these conditions are usually higher than the amount of cortisol your body needs every day, side effects from excess cortisol may develop.
It’s also probable to acquire Cushing syndrome from injectable corticosteroids — for example, routine injections for bursitis, joint, and back pain. Inhaled steroid medications (used for asthma treatment) and steroid skin creams (applied for skin disorders such as eczema) are ordinarily less likely to produce Cushing syndrome than oral corticosteroids. But, in some people, these medications may produce Cushing syndrome, particularly if taken in high doses.
Your Body’s Overproduction of Cortisol
The condition may also onset due to your body’s own overproduction of cortisol (called endogenous Cushing syndrome). This can occur from surplus production by one or both your adrenal glands, or overproduction of the adrenocorticotropic hormone (ACTH), which ordinarily manages cortisol production.
A pituitary gland tumor is also known as a pituitary adenoma. This is a noncancerous (benign) tumor of the pituitary gland, found at the bottom of the brain, which creates an excessive amount of ACTH, that happens to stimulate the adrenal glands to produce more cortisol. When this kind of syndrome develops, it’s called Cushing disease. It is known to happen more often in women and is the most common form of endogenous Cushing syndrome.
Seldomly, a tumor that develops in an organ that usually does not create ACTH will start to excessively secrete this hormone, resulting in Cushing syndrome. These tumors, which are either noncancerous (benign) or cancerous (malignant), are typically found in the thyroid, lungs, pancreas, or thymus gland.
In some individuals, the reason for Cushing syndrome is excessive cortisol secretion that is isn’t based on stimulation from ACTH and is linked with disorders of the adrenal glands. The most typical of these disorders is a noncancerous tumor of the adrenal cortex, known as an adrenal adenoma.
Cancerous tumors of the adrenal cortex (known as adrenocortical carcinomas) are quite uncommon, but they can trigger Cushing syndrome as well. Sometimes, benign, nodular enlargement of both adrenal glands can produce Cushing syndrome.
Rarely is the development of tumors caused by genetic predisposition, developing on one or more of their endocrine glands, impacting cortisol levels and forming Cushing syndrome.
- Bone loss (osteoporosis), which can happen in unusual bone fractures, such as rib fractures and fractures of the bones within the feet
- Frequent or unusual infections
- Type 2 diabetes
- High blood pressure (hypertension)
- Loss of muscle mass and strength
Cushing syndrome can be challenging to recognize and diagnose, especially endogenous Cushing syndrome since other conditions share the same symptoms and signs. Diagnosing Cushing syndrome can be an extensive and comprehensive process. You may not have any confirmed and definitive answers about your condition until you’ve had a series of medical tests, consultations, and appointments.
Your physician will administer a physical exam and examining for signs of Cushing syndrome. They may speculate Cushing syndrome if you exhibit symptoms such as rounding of the face (moon face), a layer of fatty tissue that connects the shoulders and neck (buffalo hump), and thin skin with stretch marks and bruises.
If you’ve been prescribed corticosteroid medication for an extended time, your physician may suspect that you’ve formed Cushing syndrome as an effect of this medication.
If you have not used a corticosteroid medication, these diagnostic tests may help clarify the cause:
Urine and blood tests
These tests include examining hormone levels in your urine and blood and show whether your body is excessively creating cortisol. For the urine test, you may be requested to collect a sample of your urine over a 24 hour period. Both the blood and urine samples would be provided to a laboratory to be examined for cortisol levels.
Your physician might also prescribe other specific tests that involve measuring cortisol levels before and after stimulation or suppression with other hormone medications.
Cortisol levels typically rise and fall throughout the day in those without Cushing syndrome; levels of cortisol decline significantly in the evening. By evaluating cortisol levels from a small sample of saliva collected during the night, doctors can see if your cortisol levels are too high, implying a diagnosis of Cushing syndrome.
Magnetic resonance imaging (MRI) scans or computerized tomography (CT) scans can render images of your pituitary and adrenal glands to identify malformations, such as tumors.
Petrosal sinus sampling
This test can help ascertain whether the cause of endogenous Cushing syndrome is rooted in the pituitary gland or somewhere else. For the test, blood samples are retrieved from the petrosal sinuses — veins that drain the pituitary gland.
A thin tube is implanted into your upper thigh or groin area while you’re sedated and is joined to the petrosal sinuses. Levels of ACTH are measured from the petrosal sinuses and from a blood sample typically taken from the forearm.
If the sinus sample has a higher ACTH level, the issue originates from the pituitary. If the ACTH levels are comparable between the sinuses and the forearm, the origin of the problem lies outside of the pituitary gland.
These tests aid your physician to diagnose Cushing syndrome, and they can help rule out other medical conditions with similar signs and symptoms. For instance, polycystic ovary syndrome — a hormone disorder that occurs in women with enlarged ovaries — it has similar signs and symptoms as someone with Cushing syndrome, such as excessive hair growth and irregular menstrual periods. Depression, alcoholism, and eating disorders can also somewhat mimic Cushing syndrome.
Treatments for Cushing syndrome are intended to decrease the high level of cortisol within your body. The optimal treatment for you is based on the cause of the syndrome. Options include:
Reducing Corticosteroid Use
If the reason for Cushing syndrome is long-term/extensive use of corticosteroid medications, your physician may be able to control the signs and symptoms of Cushing syndrome by decreasing the dosage of the drug over a period of time, while still sufficiently managing your arthritis, asthma or other condition.
For many of these medical issues, your physician can designate noncorticosteroid drugs, which will allow them to lower the dosage or exclude the use of corticosteroids altogether. Do not decrease the dose of corticosteroid drugs or stop taking them on your own. Do so only under your doctor’s guidance.
Abruptly stopping these medications could lead to insufficient cortisol levels. Slowly reducing the intake of corticosteroid medications enables your body to continue average cortisol production.
If a tumor is the cause of Cushing syndrome, your doctor can suggest comprehensive surgical removal. Pituitary tumors are typically eliminated by a neurosurgeon, who may conduct the procedure through your nose. If a tumor exists within the adrenal glands, pancreas, or lungs, the surgeon can extract it through a routine operation or in some cases by utilizing minimally invasive surgical techniques, with modest incisions.
After the operation, you’ll be required to take cortisol replacement medications to supply your body with the adequate amount of cortisol. In most situations, you’ll eventually experience a return of natural adrenal hormone production levels, and your physician can lessen the replacement drug’s dosage.
However, this treatment process can take nearly a year or longer. Unfortunately, in some cases, those with Cushing syndrome never encounter a resumption of normal adrenal function; they will require lifelong replacement therapy.
If the surgeon can not completely remove a pituitary tumor, he or she will ordinarily prescribe radiation therapy to be applied in combination with the surgical procedure. Additionally, radiation may be applied to people who aren’t candidates to undergo surgery.
Radiation can be prescribed in small doses over a six-week period, or with a method called stereotactic radiosurgery. In the following procedure, a large, one-time dose of radiation is conveyed on to the tumor, and the radiation exposure to encompassing tissues is reduced.
- Medications can be given to regulate cortisol production when surgery and radiation don’t accomplish treatment expectations. Medications may also be utilized before surgery in individuals who have become very ill with Cushing syndrome. Doctors may advise drug therapy prior to surgery to increase signs and symptoms and reduce surgical risk. Medical therapy may not fully correct all of the symptoms of excessive cortisol.
- Medications to regulate high levels of production of cortisol at the adrenal gland
- Mifepristone (Mifeprex, Korlym) is FDA approved for those with Cushing syndrome who also have type 2 diabetes or some level of glucose intolerance. Mifepristone does not lessen cortisol production, but it prohibits the impact of cortisol on your tissues.
- Side effects from these medications can involve nausea, muscle aches, fatigue vomiting, headaches, high blood pressure, swelling, and low potassium. Some have more-dangerous side effects, such as liver toxicity and neurological side effects.
- The newer medication for Cushing syndrome is pasireotide (Signifor), and it operates within your body by decreasing ACTH production levels from a pituitary tumor. This drug is given as an injection twice daily. It’s advised if pituitary surgery is ineffective or cannot be done.
- Side effects are quite common and may involve diarrhea, headache, abdominal pain, nausea, high blood sugar or diabetes, and fatigue.
In some situations, the tumor or its treatment will generate other hormones created by the pituitary or adrenal gland to become deficient, and your physician will suggest hormone replacement medications.
If none of these treatment options is suitable or sufficient, your physician may suggest surgical extraction of your adrenal glands (bilateral adrenalectomy). This procedure will rectify excess production of cortisol but will necessitate lifelong replacement medications.
Lifestyle and Home Remedies
The length of your rehabilitation from Cushing syndrome will depend on the severity and foundation of your condition. Understand that patience is vital and you didn’t develop Cushing syndrome overnight, as such your symptoms will not vanish overnight, either. These tips may assist you on your journey back to health and wellness.
Increase activities and exercises slowly
You may be in such a rush to get your old self back that you push yourself too hard too fast, but your impaired muscles need a slower approach. Work up to a moderate level of exercise or activity that feels comfortable without overdoing it. You’ll get better little by little, and your persistence will be rewarded.
Nutritious, wholesome foods contribute a good source of energy for your improving body and can help you lose the additional weight that you gained from Cushing syndrome. Make sure you’re receiving enough calcium and vitamin D. Taken together, they assist your body to absorb calcium, which can help restore your bones, counteracting the bone density loss that often occurs with Cushing syndrome.
Monitor your mental health
Depression can be a side effect of Cushing syndrome, but it can also continue or develop after treatment begins. Don’t overlook your depression or wait it out. Seek help immediately from your doctor or a therapist if you’re depressed, overwhelmed, or having difficulty coping during your recovery.
Gently soothe aches and pains
Massages, hot baths, and low-impact exercises, such as water aerobics and tai chi, can help to alleviate some of the muscle and joint pain that follows Cushing syndrome recovery.
Coping and support
Support groups can help deal with Cushing syndrome and recovery. They bring you together with other individuals who are coping with the same kinds of difficulties, along with their friends and families, and offer a setting in which you can share common problems.