Pituitary-Dependent Cushing's Disease

Cushing's Syndrome

Ambulatory Care,Endocrine and Metabolic

Written by the doctors and editors at UpToDate
What is Cushing's syndrome? — Cushing's syndrome is a condition that can cause lots of different medical problems, including high blood pressure, weight gain, muscle weakness, and thin skin.
Cushing's syndrome occurs when a person has too much of a hormone called "cortisol" in his or her body. Cortisol helps the body to work normally. But when people have too much cortisol, they can get symptoms.
Cortisol is made in the adrenal glands, small organs that are located on top of each kidney (figure 1). Normally, the adrenal glands make cortisol after they receive signals from the pituitary gland. The pituitary gland is a small organ that is located just below the brain.
What are the causes of Cushing's syndrome? — Cushing's syndrome can be caused by:
Taking steroid medicines – Steroids are medicines that act like cortisol in the body. People might take high doses of these medicines for asthma or some types of arthritis. These are not the same as the steroids some athletes take illegally.
Abnormal growths in the pituitary gland or other parts of the body – These can signal the adrenal glands to make too much cortisol.
Problems in the adrenal glands that cause them to make too much cortisol.
What are the symptoms of Cushing's syndrome? — People with Cushing's syndrome can have one or more of the following symptoms:
Weight gain in the face, neck, back, or belly (figure 2)
Thin skin that bruises easily. People can also have wide, reddish-purple stretch marks (picture 1).
Absent or irregular monthly periods (in women)
Increased facial hair growth (in women)
Oily skin or acne
Weak muscles in the upper arms or legs. For example, people can have trouble getting out of a chair.
Bones that can break more easily than normal
Diabetes (high blood sugar levels)
High blood pressure and heart problems
Changes in mood, such as feeling depressed, worried, or angry
Problems with learning, attention, or memory
Getting infections more easily
Blood clots in the veins in the legs
Different people can have different symptoms. If symptoms are not treated, they can get worse over time and become life-threatening.
Is there a test for Cushing's syndrome? — Yes. Your doctor or nurse will talk with you and do an exam. He or she will also do lab tests to measure the cortisol levels in your urine, blood, or saliva. If your cortisol levels are high, you will need more tests to figure out which treatment is right for you. These tests can include:
Blood tests
CT or MRI scans of your pituitary gland or adrenal glands, or other imaging tests – Imaging tests can create pictures of the inside of the body.
How is Cushing's syndrome treated? — Treatment for Cushing's syndrome depends on the cause. If you have symptoms because you take high doses of steroids, your doctor will slowly reduce your dose.
If you do not take steroids, treatment might include:
Surgery – Doctors can do different types of surgery to remove:
•Abnormal growths in the pituitary gland or other parts of the body
•One or both of the adrenal glands
Radiation therapy – Radiation can kill cells that are growing abnormally.
Medicines – Different medicines can stop the adrenal glands from making too much cortisol.
What happens after treatment? — Many people with Cushing's syndrome can be cured with treatment. But some people will need to take medicine every day for the rest of their lives to stay healthy.
While most symptoms get better with treatment, some might not go away completely. If you had trouble with attention or memory, these things might continue to be a problem. Talk to your doctor or nurse if you are worried about any of your symptoms or having a hard time coping.
What if I am pregnant and have symptoms of Cushing's syndrome? — If you are pregnant and have symptoms of Cushing's syndrome, talk with your doctor or nurse. Pregnant women with Cushing's syndrome need treatment. Without treatment, Cushing's syndrome can lead to problems like high blood pressure and diabetes during pregnancy.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15600 Version 9.0
Release: 28.2.2 - C28.105
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Cushing Disease,Cushing Syndrome,Cushing's Disease,Cushings Disease,Cushings Syndrome,Excess of Cortisol,Hypercortisolism

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