Cushing's Syndrome: Symptoms, Diagnosis and Treatment

Overview

Cushing's syndrome is a hormonal disorder caused by prolonged exposure to high levels of cortisol, a hormone produced by the adrenal glands. It can be caused by the body producing too much cortisol (endogenous) or by taking corticosteroid medications for other conditions (exogenous, the most common cause).

Endogenous Cushing's syndrome is rare and has several causes: a pituitary tumor producing ACTH (Cushing's disease, the most common form), an adrenal tumor producing cortisol, or ectopic ACTH production from a tumor elsewhere in the body. It most commonly affects adults aged 20–50 and is more common in women.

The physical changes of Cushing's — weight gain, moon face, buffalo hump, skin changes — are distinctive, but the condition is often delayed in diagnosis because symptoms develop gradually and can be attributed to other causes. Untreated, Cushing's syndrome can cause serious complications including diabetes, high blood pressure, osteoporosis, and increased risk of infections. Treatment depends on the cause and can be curative.

Symptoms

Weight gain, especially around the abdomen and face ('moon face')
Fat accumulation between the shoulders and neck ('buffalo hump')
Purple stretch marks on the abdomen, thighs, and breasts
Thin and fragile skin that bruises easily
Slow-healing cuts and infections
Muscle weakness, especially in the upper arms and thighs
Fatigue
High blood pressure
High blood sugar or diabetes
Mood changes — depression, anxiety, irritability
Irregular or absent menstrual periods
Decreased sex drive
Excess facial and body hair in women

Diagnosis

Late-night salivary cortisol test — cortisol should be low at night; elevated levels suggest Cushing's
24-hour urine cortisol test — measures total cortisol output over a day
Dexamethasone suppression test — dexamethasone should suppress cortisol; failure to do so suggests Cushing's
Blood tests — ACTH levels to determine if the cause is pituitary, adrenal, or ectopic
Imaging — MRI of the pituitary, CT of the adrenal glands, or imaging to find ectopic tumors
Petrosal sinus sampling — to confirm pituitary source of ACTH

An endocrinologist makes the diagnosis.

Treatments

Reducing corticosteroid medications — if the cause is exogenous (medication-induced), gradually tapering the dose under medical supervision
Surgery — transsphenoidal surgery to remove pituitary tumors (Cushing's disease) or adrenalectomy for adrenal tumors
Medications — ketoconazole, metyrapone, or mifepristone to reduce cortisol production or effects
Radiation therapy — for pituitary tumors that can't be completely removed surgically
Bilateral adrenalectomy — removal of both adrenal glands for severe cases; requires lifelong hormone replacement
Post-surgery hormone replacement — cortisol replacement while the body recovers normal adrenal function
Regular monitoring — cortisol levels, bone density, blood pressure, and blood sugar
Lifestyle — bone health (calcium, vitamin D), weight management, mental health support

Medical Resources

Your Care Plan

A step-by-step guide to navigating your condition, from finding the right doctors to advocating for the care you deserve.

Step 1: Doctors to See

Start with: Your primary care physician for initial cortisol testing.

Then seek: An endocrinologist for diagnosis and treatment.

Build your team:

Endocrinologist — for diagnosis and medical management
Neurosurgeon — if pituitary tumor surgery is needed
Endocrine surgeon — if adrenal surgery is needed
Radiation oncologist — if radiation therapy is needed
Mental health professional — for mood changes and body image
Ophthalmologist — if pituitary tumor affects vision

Step 2: Advocate for Yourself

If you have progressive weight gain, skin changes, muscle weakness, and mood changes, ask about cortisol testing. Cushing's is often missed because symptoms are attributed to lifestyle or aging. If you're taking corticosteroids (prednisone) for another condition, discuss whether your symptoms could be medication-related. If your late-night cortisol is elevated but tests are inconclusive, ask for repeat testing — Cushing's can be intermittent. If a pituitary tumor is found, seek a neurosurgeon experienced in pituitary surgery.

Step 3: Your Action Plan

Get cortisol tests — late-night salivary cortisol and 24-hour urine cortisol.
Get a dexamethasone suppression test.
See an endocrinologist for definitive diagnosis.
Determine the cause — pituitary, adrenal, ectopic, or medication.
If a tumor is found, discuss surgical removal with an experienced surgeon.
If medication-induced, work with your doctor to reduce steroids safely.
After treatment, discuss cortisol replacement if needed.
Monitor bone density, blood pressure, and blood sugar long-term.

Important: This report is educational information, not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions.