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Cushing's Syndrome and Cushing's Disease.

American Family Physician
September 1, 2000

What is Cushing's syndrome?

"Cushing's syndrome" is the name for what happens when your body makes too much cortisol. Cortisol is a natural steroid hormone that's like the "cortisone" in some medicines. Your body might make too much cortisol or you might take too much cortisone-like drugs and end up with Cushing's syndrome.

What causes Cushing's syndrome?

The most common cause of Cushing's syndrome is taking cortisone-like medicines orally (by mouth) every day for weeks to months. Prednisone is the most common medicine that's taken this way.

Inhaled steroid medicines for asthma and steroid skin creams for eczema and other skin conditions don't cause Cushing's syndrome. Even oral medicines taken every day for short periods of time or every other day for longer periods don't often cause a problem.

Be sure to tell your doctor if you're taking any other medicine or herbal product.

The next most common cause of Cushing's syndrome is Cushing's disease. Other causes are tumors in the adrenal glands or somewhere else in the body.

What is Cushing's disease?

"Cushing's disease" is the name doctors use when Cushing's syndrome is caused by a tumor in the pituitary gland. The pituitary gland is on the bottom of the brain. This gland controls the body's production of cortisol. These small tumors can cause the adrenal glands, which are near the kidneys, to make too much cortisol.

The pituitary gland tumors in Cushing's disease aren't usually cancerous. However, if these tumors are allowed to get too big, they can cause problems with your eyesight.

What are the signs and symptoms of Cushing's syndrome and disease?

One common symptom is weight gain. Fat deposits can form around your stomach and upper back. Arms and legs stay thin and don't usually get fatter.

Your skin gets thinner and is easily bruised. Cuts, scratches and insect bites take a long time to heal. Pink or purple stretch marks may form on your skin. Your face gets round and puffy.

You may feel tired and have weak muscles. You may feel depressed. Women usually have irregular menstrual periods and may grow thick or more visible body hair.

High blood pressure, osteoporosis and diabetes can be signs of Cushing's syndrome or disease.

Infections take longer to heal. If you often get skin infections or other infections, especially if the infections are unusual, you may have Cushing's syndrome or disease.

How does my doctor find out if I have Cushing's syndrome or disease?

Your doctor may start by asking you questions and doing a physical exam. If the cause is a medicine you are taking, no tests are needed. If your doctor thinks that you have Cushing's syndrome or disease, but no medicines are causing it, you may need to have some blood and urine tests.

Your doctor may ask you to collect your urine for 24 hours. Be sure to do what the doctor tells you to do for this test. Your doctor may have you take a medicine called dexamethasone before your blood or urine is collected. This tests your body's response to steroids.

At some point, you may need a CT scan or an MRI. These tests show a "picture" of your insides.

How are Cushing's disease and syndrome treated?

If you have Cushing's disease, a doctor will remove the tumor from your pituitary gland. The surgery is usually a success. Radiation treatments are sometimes used after surgery. You'll need to take cortisone-like medicines for several months after the tumor is removed. You'll need to follow your treatment plan very carefully.

COPYRIGHT 2000 American Academy of Family Physicians

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