Cushing Syndrome – Symptoms and Causes
Overview
Cushing syndrome occurs when the body has excessive cortisol over an extended period or when someone takes glucocorticoid medications, which have similar effects as cortisol.
The high cortisol levels create distinctive physical changes, including:
- A rounded, “moon-shaped” face
- Fatty deposit between the shoulders (sometimes called a “buffalo hump”)
- Pink or purple stretch marks on the skin
Beyond these visible symptoms, Cushing syndrome can lead to serious health complications like:
- High blood pressure
- Bone loss
- Type 2 diabetes in some cases
Early treatment is essential for managing Cushing syndrome. When doctors reduce cortisol levels through appropriate treatments, symptoms typically improve, and patients have better recovery outcomes.
Signs and Symptoms
People with Cushing syndrome often show several distinct body changes due to excess cortisol. They typically gain weight mainly in their trunk while arms and legs remain thin. Their face may become rounder and fuller, sometimes called “moon face.”
Many develop a fatty pad between the shoulders that resembles a hump. Purple or pink stretch marks often appear on the stomach, thighs, breasts, hips, and underarms. The skin becomes thinner, more delicate, and bruises easily.
Other common issues include:
- Slow-healing wounds
- Acne outbreaks
- Increased susceptibility to infections
Female-Specific Symptoms
Women with Cushing syndrome may experience:
- Unusual facial and body hair growth (hirsutism)
- Irregular menstrual cycles
- Complete cessation of periods
Male-Specific Symptoms
Men with Cushing syndrome commonly face:
- Decreased sexual desire
- Fertility problems
- Erectile dysfunction
Additional Possible Symptoms
Cushing syndrome can cause many other health problems:
- Extreme fatigue
- Muscle weakness
- Mental health issues (depression, anxiety)
- Mood swings
- Memory and concentration problems
- Insomnia
- High blood pressure
- Frequent headaches
- Darkening skin
- Bone loss and fractures
- Stunted growth in children
When Medical Care Is Needed
Contact your healthcare provider if you notice symptoms of Cushing syndrome. This is especially important if you take glucocorticoid medications for conditions like asthma, arthritis, or inflammatory bowel disease. Early diagnosis can help prevent complications.
What Causes Cushing Syndrome
Cushing syndrome often develops from taking glucocorticoid medications for long periods. Doctors prescribe these medicines to treat many inflammatory conditions like rheumatoid arthritis, lupus, and asthma.
They’re also commonly used for back pain, joint injuries, and various skin rashes. Patients who receive organ transplants may take these medications to prevent rejection.
These medications come in several forms:
- Pills taken by mouth
- Injections
- Creams applied to the skin
- Inhalers that deliver medicine to the lungs
Any of these forms can cause Cushing syndrome when used in large amounts over extended periods. The medicine works similarly to your body’s natural cortisol but can build up to harmful levels.
Sometimes the body itself makes too much cortisol, creating what doctors call endogenous Cushing syndrome. This happens in several ways:
Pituitary Tumors
Small, non-cancerous growths in the pituitary gland (located at the base of the brain) can produce too much ACTH hormone. This extra ACTH signals the adrenal glands to make more cortisol than the body needs.
This specific form is called Cushing disease and occurs more commonly in women. It represents the most frequent type of naturally occurring Cushing syndrome.
Tumors Outside Normal Hormone-Producing Areas
In rare cases, tumors growing in organs that don’t typically make hormones begin producing ACTH. These “ectopic” tumors can be found in the:
- Lungs
- Pancreas
- Thyroid
- Thymus gland
Some of these tumors are cancerous, while others are benign (non-cancerous), but all can trigger excess cortisol production.
Adrenal Gland Problems
Several adrenal gland issues can cause too much cortisol production:
- Non-cancerous tumors called adrenal adenomas (most common)
- Rare cancerous tumors (adrenocortical carcinoma)
- Multiple growths throughout the adrenal glands (adrenal nodular hyperplasia)
Inherited Conditions
In rare cases, Cushing syndrome runs in families. Some people inherit a tendency to develop hormone-producing tumors in their endocrine glands. If these tumors produce either ACTH or cortisol directly, Cushing syndrome can develop.
When cortisol levels stay high for too long, they disrupt many body functions including blood pressure regulation, inflammation control, blood sugar management, and energy production from food.
Complications
Without proper care, Cushing syndrome can lead to several health problems. Patients may develop bone loss (osteoporosis), increasing their risk of fractures.
High blood pressure often occurs and can damage the heart and blood vessels.
Type 2 diabetes is another common complication. The body becomes less able to fight illness, leading to frequent or severe infections.
Many patients also experience significant muscle weakness as their muscle mass decreases.
