Saturday, July 23, 2011

Cushing's Syndrome

Overview, Causes, & Risk Factors

Cushing's syndrome is a hormonal disorder that occurs when the body tissues are exposed to high levels of the hormone cortisol. The adrenal glands produce cortisol. Cushing's disease is the most common type of Cushing's syndrome. It is caused by a noncancerous tumor of the pituitary gland.
What is going on in the body?
Cushing's syndrome occurs when body tissues are exposed to high levels of cortisol for a long time. Cortisol is an important hormone that regulates many body functions, including stress management. A part of the brain known as the hypothalamus sends CRH, a hormone, to the pituitary gland. The pituitary gland then produces another hormone called ACTH. The ACTH then stimulates the adrenal glands to produce cortisol. The hypothalamus and pituitary monitor blood levels of cortisol. They adjust their hormone release as needed. This maintains a normal balance of cortisol.
Sometimes the cortisol balance in the body is thrown off. The person may have excess cortisol under the following conditions:

  • he or she takes glucocorticoid medicines, such as prednisone, for a long time



  • tumors of the pituitary gland produce excess ACTH



  • tumors outside the pituitary secrete ACTH



  • abnormalities, including tumors, of the adrenal glands cause excess cortisol production
    What are the causes and risks of the disease?
    Cushing's syndrome occurs when body tissues are exposed to high levels of cortisol over a long period of time. These high levels may be caused by:



  • certain cancerous or noncancerous tumors of the lung, thyroid, pancreas, or ovary. These tumors produce a form of Cushing's syndrome known as ectopic ACTH syndrome.



  • disorders of the adrenal glands



  • familial Cushing's syndrome, which involves tumors of one or more endocrine glands



  • pituitary adenoma, a noncancerous tumor that causes Cushing's disease



  • prolonged use of glucocorticoid medicines, such as prednisone



  • tumors of the adrenal glands, which may be cancerous or noncancerous


    • Symptoms & Signs

    What are the signs and symptoms of the disease?
    Signs and symptoms of Cushing's syndrome vary but may include:

  • fragile, thin skin that bruises easily



  • high blood glucose



  • increased fat around the neck



  • irritability, anxiety, and depression



  • muscle weakness



  • obesity in the upper body



  • severe fatigue
    Women with Cushing's syndrome may have excessive hair growth on their faces, necks, trunks, and thighs. They may have absent or irregular menstruation. Men with may have decreased fertility and decreased or absent sexual desire. In children, the syndrome may cause obesity and slow growth rates.


    • Diagnosis & Tests

    How is the disease diagnosed?
    Diagnosis of Cushing's syndrome begins with a medical history and physical exam. The healthcare provider may order additional tests, including:

  • blood and urine tests to pinpoint the source of the excess cortisol



  • CT scans and MRIs of various endocrine organs



  • urine tests to measure cortisol excreted in the urine


    • Prevention & Expectations

    What can be done to prevent the disease?
    Many times, Cushing's syndrome cannot be prevented. Judicious use of glucocorticoid medicines is important. Many times, however, high levels are needed to control diseases.
    What are the long-term effects of the disease?
    If Cushing's syndrome is untreated, body tissues continue to be exposed to high cortisol levels. The person may develop the following conditions:

  • diabetes



  • high blood pressure



  • muscle weakness



  • obesity



  • osteoporosis, or bone thinning
    What are the risks to others?
    Cushing's syndrome is not contagious and does not put others at risk.


    • Treatment & Monitoring

    What are the treatments for the disease?
    Treatment of Cushing's syndrome varies, depending on the source of the excess cortisol. Treatment options include:

  • chemotherapy



  • immunotherapy



  • mitotane, which keeps cortisol production down



  • radiation therapy



  • surgical removal of adrenal glands



  • surgical removal of tumors
    What are the side effects of the treatments?
    Surgery may cause bleeding, infection, or allergic reaction to anesthesia.
    What happens after treatment for the disease?
    Some individuals may produce less steroid hormones. They may need steroid hormones after treatment to maintain normal levels.
    How is the disease monitored?
    Someone with Cushing's syndrome will have regular visits with the healthcare provider. The provider may order periodic blood and urine tests to monitor the problem. Any new or worsening symptoms should be reported to the provider.


    • Attribution

    Author:Bill Harrison, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:06/30/01
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:06/04/01
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